title: Intraoperative phenylephrine infusion decreases the magnitude of redistribution hypothermia.
abstract: 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 alpha-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 microgram.kg-1.min-1 phenylephrine i.v. or no treatment (control). The phenylephrine infusion was started immediately before anesthesia was induced with 2.5 mg/kg propofol i.v. Subsequently, anesthesia was maintained with sevoflurane and 60% nitrous oxide in oxygen. Calf minus toe, skin-temperature gradients < 0 degree 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 degrees C) than in those given phenylephrine (0.5 +/- 0.2 degree 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, Japan. tikeda@hama-med.ac.jp
authors.forename: T
authors.initials: T
authors.lastname: Ikeda
authors.forename: M
authors.initials: M
authors.lastname: Ozaki
authors.forename: D I
authors.initials: DI
authors.lastname: Sessler
authors.forename: T
authors.initials: T
authors.lastname: Kazama
authors.forename: K
authors.initials: K
authors.lastname: Ikeda
authors.forename: S
authors.initials: S
authors.lastname: Sato
mesh_terms: D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage*; D000328:Adult; D000768:Anesthesia, General / Q000009:adverse effects; D001833:Body Temperature Regulation / Q000187:drug effects*; D005260:Female; D006801:Humans; D007035:Hypothermia / Q000209:etiology / Q000503:physiopathology*; D007262:Infusions, Intravenous; D007431:Intraoperative Complications / Q000503:physiopathology*; D007432:Intraoperative Period; D008297:Male; D010656:Phenylephrine / Q000008:administration & dosage*; D014661:Vasoconstriction; D014664:Vasodilation
chemical_list: D000316:Adrenergic alpha-Agonists; D010656:Phenylephrine