Management of intraoperative pulmonary oedema in a child following systemic absorption of phenylephrine eyedrops.


Consultant Anaesthetist. In response to Appadurai and Hanna's letter, we would make the following points. (i) Our paper is entitled `Analgesia for pelvis brachytherapy' rather than `anaesthesia'. Pain can be a major problem when patients awake from anaesthesia and the major purpose of the paper was to comment on techniques used to reduce postoperative pain. We did comment about the use of high dose brachytherapy treatments in our review (page 271), but we gave more attention to low dose rate treatments because postoperative pain is a greater problem in this group of patients. Moreover, a survey in 1994 showed that 97% of UK departments were using low dose rate apparatus, but we would acknowledge that there is a trend toward the adoption of high dose rate apparatus. (ii) Undoubtedly, a multi-disciplinary preoperative assessment clinic is extremely useful, especially in remote stand-alone oncology units. (iii) With the increasing use of combined chemoradiotherapy to treat carcinoma of the cervix, bone marrow suppression is an important consideration that needs to be taken into account prior to anaesthesia. However, the risk of sepsis must be balanced against tumour repopulation during the time the bone marrow is recovering. Personal experience has shown that intrauterine insertions can be carried out safely with an overall white count of 1.5±2 mm, as long as there is no pre-existing vaginal or uterine infection and the patients receive prophylactic antibiotics. (iv) Propofol maintenance of anaesthesia is indeed a popular intraoperative technique in many disciplines. If the technique is continued via a target controlled infusion into the postoperative radiotherapy treatment phase, we would recommend the continuous presence of a trained anaesthetist, which is time and labour intensive as discussed in our article. (v) Brachytherapy for prostate cancer is an increasing trend in the UK, although currently this is practised in only a few centres. We acknowledge that we have not dealt with this technique in our review, which is largely based on our own clinical experience and practice. It is interesting to learn that subarachnoid block provides good analgesia for this technique. In response to Fitz-Henry and Chan's letter, although our article was primarily concerned with postoperative analgesia, we welcome their description of spinal anaesthesia for low dose rate selectron insertion, which is used in our institution in cases of obesity or respiratory disease. We very much agree with your efforts to avoid postoperative nausea and vomiting, dehydration, and promotion of multi-modal analgesia. One of the authors (MDS) of our review has studied intrathecal, diamorphine for pain relief in major bowel surgery and like many other obstetric anaesthetists, utilizes the technique for Caesarean sections. This agent would be expected to have a signi®cant analgesic effect for up to 12 h into radiotherapy treatment. However, we would stress that any elderly or medically un®t cases would require close respiratory monitoring for episodes of early respiratory depression occurring up to 6 h after spinal administration.

Cite this paper

@article{Krovvidi2002ManagementOI, title={Management of intraoperative pulmonary oedema in a child following systemic absorption of phenylephrine eyedrops.}, author={Hari Krovvidi and Pratima Kulkarni}, journal={British journal of anaesthesia}, year={2002}, volume={89 2}, pages={343; author reply 343-4} }