In Response

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Dr Roth1 raises an interesting point in proposing that prophylactic phenylephrine infusions may attenuate spinal anesthesia–induced hypothermia. We agree that temperature-related data might prove helpful in this area of research. Currently, it is not routinely reported in even the best-conducted studies.2,3 Dr Roth1 mentions evidence for phenylephrine attenuating redistribution hypothermia under general anesthesia. There is also limited evidence that it has a similar effect in spinal anesthesia, although in patients undergoing orthopedic surgery.4
Core temperature is difficult to reliably measure during spinal anesthesia. In an elegant recent study, du Toit et al5 used ingestible telemetric temperature sensors to record core temperature change during elective cesarean delivery under spinal anesthesia. They demonstrated that 50% of parturients experience hypothermia (<36.0°C) that extended well beyond completion of surgery. Technology such as this could facilitate research in this area with a view to investigating the theory Dr Roth1 has advanced.
Our study was designed primarily to demonstrate the feasibility and efficacy of prophylactic phenylephrine infusions in a resource-constrained environment. While temperature monitoring is advised in our theaters, we were not able to standardize either the method of temperature recording or ambient theater temperature. Our study was also not powered to show temperature differences between the 2 groups. Further, both groups received phenylephrine (bolus or infusion)—this may have limited an observable effect. We did not therefore collect the temperature-related data.
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