Phenylephrine toxicity

The patient's nose was prepared for surgery with injection of 2 mL of lidocaine 1% + epinephrine 1 in 80 000 to the skin, followed by a nasal pack which was soaked in 2 mL of 5% cocaine (total dose 100 mg) and, erroneously, ten 0.5 mL vials of 10% phenylephrine (total dose 500 mg). A 12-lead ECG was performed which showed ST depression across the lateral leads in keeping with the pattern of strain caused by the sudden increase in BP, and a decision was made to abandon surgery.