Phenylephrine infusions for maintaining blood pressure during spinal anesthesia for cesarean delivery: Finding the shoe that fits

摘要

Much has changed in the way we manage blood pressure during spinal anesthesia for cesarean delivery. There is now less reliance on IV fluid, the advent of the combined spinal-epidural technique has allowed the use of smaller intrathecal doses, and most significantly, phenylephrine has graduated from being the new kid on the block to a routine, and arguably, preferred vaso-pressor. Debate has now shifted from whether we should use phenylephrine to how we use it. One method that has garnered attention is the use of prophylactic infusions1; this has been the technique of choice in my department for more than a decade.What are the advantages of a phenylephrine infusion? Are there disadvantages? Should it be used in routine clinical practice? What advice can be given to those wishing to adopt the technique?