Oxymetazoline-induced postoperative hypertension

Oxymetazoline is a topical sympathomimetic agent that is commonly used in over-the-counter nasal decongestant sprays. It is an imidazoline derivative that causes vasoconstriction of blood vessels by its direct effect on α-adrenergic receptors. Its vasoconstrictive action is used during otorhinolaryngological procedures to improve visualization of the airway and to minimize postoperative bleeding. Although used as a topical vasoconstrictor, when administered in larger doses, systemic absorption of oxymetazoline may lead to serious complications. We report the development of postoperative hypertension in a 3-year-old child caused by the application of oxymetazoline nasal packing following inferior turbinate reduction. The potential adverse effects of oxymetazoline are presented, previous reports reviewed, and options for management discussed.