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GENERAL ARTICLES

Intraoperative Phenylephrine Infusion Decreases the Magnitude of Redistribution Hypothermia

Takehiko Ikeda, MD^*, Makoto Ozaki, MD, Daniel I. Sessler, MD, Tomiei Kazama, MD^*, Kazuyuki Ikeda, MD, FRCA^*, and Shigehito Sato, MD^*

*Department of Anesthesiology and Intensive Care and Outcomes Research^TM Group, Hamamatsu University School of Medicine, Hamamatsu; Department of Anesthesia, Tokyo Women’s Medical University, Tokyo, Japan; Department of Anesthesia and Perioperative Care, University of California-San Francisco, California; Ludwig Boltzmann Institute for Clinical Anesthesia and Intensive Care; and Department of Anesthesia and General Intensive Care, University of Vienna, Vienna, Austria

Address correspondence and reprint requests to Dr. Takehiko Ikeda, Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, 3600 Handa-cho, Hamamatsu 431-3192, Japan. Address e-mail to tikeda{at}hama-med.ac.jp

Core hypothermia during the first hour after induction of general anesthesia results largely from an internal core-to-peripheral redistribution of body heat. This redistribution results from both central inhibition of tonic thermoregulatory vasoconstriction in the arteriovenous shunt and anesthetic-induced vasodilation. We therefore tested the hypothesis that acute administration of phenylephrine, a pure -adrenergic agonist, reduces the magnitude of anesthetic-induced core-to-peripheral redistribution of body heat. Patients undergoing minor oral surgery were randomly assigned to an infusion of 0.5 µg · kg^-1 · min^-1 phenylephrine IV or no treatment (control). The phenylephrine infusion was started immediately before anesthesia was induced with 2.5 mg/kg propofol IV. Subsequently, anesthesia was maintained with sevoflurane and 60% nitrous oxide in oxygen. Calf minus toe, skin-temperature gradients <0°C were considered indicative of significant arteriovenous shunt vasodilation. Ambient temperature and end-tidal concentrations of maintenance sevoflurane were comparable in each group. Although there were no significant differences in skin-temperature gradients, core temperatures in the untreated patients decreased significantly more (1.2 ± 0.4°C) than in those given phenylephrine (0.5 ± 0.2°C, P < 0.001). These data suggest that maintaining precapillary vasoconstriction of blood vessels, not in the arteriovenous shunt reduces the magnitude of redistribution hypothermia.

Implications: Core hypothermia immediately after induction of general anesthesia results largely from core-to-peripheral redistribution of body heat. Core temperature reduction during the first hour of anesthesia decreased less in patients given phenylephrine than in untreated controls. These data suggest that maintaining precapillary vasoconstriction possibly reduces the magnitude of redistribution hypothermia.

This article has been cited by other articles:

				T. Ikeda, T. Kazama, D. I. Sessler, S. Toriyama, K. Niwa, C. Shimada, and S. Sato Induction of Anesthesia with Ketamine Reduces the Magnitude of Redistribution Hypothermia Anesth. Analg., October 1, 2001; 93(4): 934 - 938. [Abstract] [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999