Another Possible Reason to Use Prophylactic Phenylephrine Infusions to Reduce Spinal Anesthesia–Associated Hypotension: Do These Patients Stay Warmer?

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Bishop et al1 demonstrated that prophylactic phenylephrine infusions reduce severe spinal anesthesia hypotension. The vasodilation from spinal anesthesia is one mechanism contributing to patients becoming hypothermic.2 Redistribution hypothermia results from vasodilation. In patients receiving general anesthesia, prophylactic infusions of phenylephrine reduce the magnitude of redistribution hypothermia.3 It thus seems plausible that prophylactic infusions of phenylephrine would also reduce hypothermia during spinal anesthesia.
It is difficult to measure accurate core temperatures in this population, and it is not commonly done. Using the incidence of shivering as a surrogate measure may be problematic. Because skin temperature significantly affects the patient’s response, paradoxically, a colder patient may shiver less.2 It would be interesting to know whether Bishop et al1 were fortunate enough to collect any temperature-related data. Both hypotension and hypothermia result from vasodilation; they are linked. In future studies in this area, cocollection of temperature data, if possible, would be helpful. Demonstrating a thermal benefit would provide another reason to use prophylactic phenylephrine infusions. Hypothermia has multiple adverse consequences and should be avoided.

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