Postoperative critical care: overnight intensive recovery.

equally in ENT and ophthalmic theatres. However, those recommendations relating to phenylephrine concentration and dose appear to be speci®cally relevant to ENT surgery. The weakest commercially available ocular phenylephrine preparation is 2.5%. It is doubtful whether a 10-fold reduction in phenylephrine concentration would result in clinically useful pupillary dilatation. Had our surgeons used 2.5% rather than 10% phenylephrine, in keeping with the British National Formulary (BNF) recommendation we cited in our case report, the dose administered to our patient would still have been more than ®ve times greater than the initial dose of 20 mg kg suggested in the New York State Guidelines. Presumably ocular doses of this magnitude are widely deemed acceptable because phenylephrine absorption from the intact conjunctiva and nasolacrimal duct is much less than would be expected from a bleeding adenoidectomy site. In our view, the most signi®cant factor leading to excessive phenylephrine absorption in our patient was the short interval between application of the eyedrops and the conjunctival incision. Had the eyedrops been administered as prescribed, preoperatively on the ward, the complication may not have occurred. Other general preventative strategies speci®cally applicable to ophthalmic surgery were discussed in our article. As regards a possible role for oxymetazoline, ocular phenylephrine is used to effect mydriasis rather than vasoconstriction. It is the only sympathomimetic listed for this purpose in the BNF and we are unaware of an appropriate alternative.