{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T12:24:05Z","timestamp":1790771045770,"version":"4.1.0"},"reference-count":23,"publisher":"American Academy of Pediatrics (AAP)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,11,1]]},"abstract":"<jats:p>The over-the-counter nasal decongestant oxymetazoline (eg, Afrin) is used in the pediatric population for a variety of conditions in the operating room setting. Given its vasoconstrictive properties, it can have cardiovascular adverse effects when systemically absorbed. There have been several reports of cardiac and respiratory complications related to use of oxymetazoline in the pediatric population. Current US Food and Drug Administration approval for oxymetazoline is for patients \u22656 years of age, but medical professionals may elect to use it short-term and off label for younger children in particular clinical scenarios in which the potential benefit may outweigh risks (eg, active bleeding, acute respiratory distress from nasal obstruction, acute complicated sinusitis, improved surgical visualization, nasal decongestion for scope examination, other conditions, etc). To date, there have not been adequate pediatric pharmacokinetic studies of oxymetazoline, so caution should be exercised with both the quantity of dosing and the technique of administration. In the urgent care setting, emergency department, or inpatient setting, to avoid excessive administration of the medication, medical professionals should use the spray bottle in an upright position with the child upright. In addition, in the operating room setting, both monitoring the quantity used and effective communication between the surgeon and anesthesia team are important. Further studies are needed to understand the systemic absorption and effects in children in both nonsurgical and surgical nasal use of oxymetazoline.<\/jats:p>","DOI":"10.1542\/peds.2021-054271","type":"journal-article","created":{"date-parts":[[2021,10,4]],"date-time":"2021-10-04T14:09:37Z","timestamp":1633356577000},"source":"Crossref","is-referenced-by-count":20,"title":["Topical Nasal Decongestant Oxymetazoline: Safety Considerations for Perioperative Pediatric Use"],"prefix":"10.1542","volume":"148","author":[{"given":"Richard","family":"Cartabuke","sequence":"first","affiliation":[{"name":"aOutpatient Anesthesia Services"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph D.","family":"Tobias","sequence":"additional","affiliation":[{"name":"bDepartment of Anesthesiology and Pain Medicine, Nationwide Children\u2019s Hospital and Department of Anesthesiology and Pain Medicine, The Ohio State University, Columbus, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kris R.","family":"Jatana","sequence":"additional","affiliation":[{"name":"cDepartment of Pediatric Otolaryngology, Nationwide Children\u2019s Hospital and Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"SECTION ON ANESTHESIOLOGY AND PAIN MEDICINE, SECTION ON OTOLARYNGOLOGY\u2013HEAD AND NECK SURGERY","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2021,11,1]]},"reference":[{"issue":"6","key":"2022081819020998900_B1","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1111\/j.1472-8206.2009.00805.x","article-title":"Alpha-adrenoceptor agonistic activity of oxymetazoline and xylometazoline","volume":"24","author":"Haenisch","year":"2010","journal-title":"Fundam Clin Pharmacol"},{"issue":"1","key":"2022081819020998900_B2","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/0952-8180(90)90043-3","article-title":"A comparison of cocaine, lidocaine with epinephrine, and oxymetazoline for prevention of epistaxis on nasotracheal intubation","volume":"2","author":"Katz","year":"1990","journal-title":"J Clin Anesth"},{"issue":"7","key":"2022081819020998900_B3","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1288\/00005537-199207000-00012","article-title":"Comparison of vasoconstrictors for functional endoscopic sinus surgery in children","volume":"102","author":"Riegle","year":"1992","journal-title":"Laryngoscope"},{"issue":"2","key":"2022081819020998900_B4","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1002\/lary.21286","article-title":"Systematic review of topical vasoconstrictors in endoscopic sinus surgery","volume":"121","author":"Higgins","year":"2011","journal-title":"Laryngoscope"},{"issue":"4","key":"2022081819020998900_B5","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1097\/00000542-198310000-00009","article-title":"Identification of receptor mechanism mediating epinephrine-induced arrhythmias during halothane anesthesia in the dog","volume":"59","author":"Maze","year":"1983","journal-title":"Anesthesiology"},{"issue":"10","key":"2022081819020998900_B6","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1111\/pan.12192","article-title":"Oxymetazoline and hypertensive crisis in a child: can we prevent it?","volume":"23","author":"Latham","year":"2013","journal-title":"Paediatr Anaesth"},{"issue":"2","key":"2022081819020998900_B7","first-page":"72","article-title":"Oxymetazoline-induced postoperative hypertension","volume":"1","author":"Ramesh","year":"2013","journal-title":"Pediatric Anesthesia and Critical Care Journal"},{"issue":"6","key":"2022081819020998900_B8","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1017\/S1047951109990722","article-title":"Are nasal decongestants safer than rhinitis? 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Accessed September 28, 2021"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2021-054271\/1354003\/peds_2021054271.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2021-054271\/1354003\/peds_2021054271.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,8,18]],"date-time":"2022-08-18T19:02:47Z","timestamp":1660849367000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/148\/5\/e2021054271\/181370\/Topical-Nasal-Decongestant-Oxymetazoline-Safety"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,1]]},"references-count":23,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021,11,1]]},"published-print":{"date-parts":[[2021,11,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2021-054271","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,1]]},"article-number":"e2021054271"}}