{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T13:41:15Z","timestamp":1787060475302,"version":"build-2736575974"},"reference-count":27,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2013,5,16]],"date-time":"2013-05-16T00:00:00Z","timestamp":1368662400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2013,10]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Oxymetazoline nasal spray is not\n                      <jats:styled-content style=\"fixed-case\">FDA<\/jats:styled-content>\n                      approved for use in children less than 6\u00a0years; however, its safety and efficacy are widely accepted, and it is in widespread use in children prior to procedures that may lead to epistaxis. We report a case of intraoperative oxymetazoline toxicity in a 4\u2010year\u2010old boy that led to a hypertensive crisis. While examining the possible causes for this problem, we became aware that the method of drug delivery led to an unanticipated overdose. The position in which the bottle is held causes pronounced variation in the quantity of oxymetazoline dispensed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>To examine the impact that bottle position has on the volume delivered, we measured the volume of oxymetazoline dispensed with the bottle in the upright and inverted position. We also measured the volume of a drop of oxymetazoline dispensed from the bottle. Because an additional source of oxymetazoline exposure is from packing the nares with surgical pledgets, we analyzed the volume of oxymetazoline absorbed by each pledget.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Squeezing the bottle in the upright position results in a fine spray of fluid that averaged 28.9\u00a0\u00b1\u00a06.8\u00a0\u03bcl and was largely independent of effort. This volume is nearly identical to the measured volume of a drop of oxymetazoline, which was 30\u00a0\u03bcl. However, squeezing the bottle in the inverted position resulted in a steady stream of fluid, and the volume administered was completely effort dependent. Multiple tests in the inverted position demonstrated an average volume of 1037\u00a0\u00b1\u00a0527\u00a0\u03bcl, with a range of 473\u20132196\u00a0\u03bcl. Lastly, the volume of oxymetazoline absorbed by each surgical pledget was 1511\u00a0\u00b1\u00a0184\u00a0\u03bcl.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Our testing indicates that bottle position during oxymetazoline administration can cause up to a 75\u2010fold increase in intended drug administration.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/pan.12192","type":"journal-article","created":{"date-parts":[[2013,5,16]],"date-time":"2013-05-16T10:10:37Z","timestamp":1368699037000},"page":"952-956","source":"Crossref","is-referenced-by-count":30,"title":["Oxymetazoline and hypertensive crisis in a child: can we prevent it?"],"prefix":"10.1111","volume":"23","author":[{"given":"Gregory J.","family":"Latham","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine Seattle Children's Hospital University of Washington School of Medicine Seattle WA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David S.","family":"Jardine","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine Seattle Children's Hospital University of Washington School of Medicine Seattle WA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,5,16]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/0952-8180(90)90043-3"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1288\/00005537-199207000-00012"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.21286"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aeq205"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1472-8206.2009.00805.x"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pupt.2007.06.007"},{"key":"e_1_2_9_8_1","unstructured":"Micromedex\u00ae 2.0 (electronic version). 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