Abstract
Department of Anesthesia; Akita University, School of Medicine; Akita 010, Japan;mtanaka@med.akita-u.ac.jp(Accepted for publication March 20, 1998.)To the Editor:-We have read with interest the article by Sakura et al., [1]in which they attributed the transient neurologic deficit seen in patients after spinal anesthesia to phenylephrine added to tetracaine solution. Regrettably the authors failed to acknowledge that the commercially available 0.5% phenylephrine solution (Kowa, Nagoya, Japan) contained 0.1% sodium bisulfite, well known for its neurotoxicity when administered neuraxially. [2,3]The amount of sodium bisulfite given in their patients ranged from 0.5 to 0.75 mg, approximately half the dose that caused permanent hind-limb paralysis in rabbits [2]and approximately one tenth the concentration that caused irreversible spinal monosynaptic reflex in rats. [3]Unless preservative-free phenylephrine solution is used in combination with tetracaine, phenylephrine, per se, cannot be regarded as an etiology of the reported transient neurologic sequelae.Makoto Tanaka, M.D.Toshiaki Nishikawa, M.D.Department of Anesthesia; Akita University, School of Medicine; Akita 010, Japan;mtanaka@med.akita-u.ac.jp
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