Vasoconstrictor-mediated thermogenesis present in perfused skeletal muscle but absent from perfused heart

Intraoperative phenylephrine infusion to reduce perioperative shivering in lower segment caesarean section: A randomised controlled study

BACKGROUND

Shivering is described as an involuntary, repetitive activity of the skeletal muscles that can have deleterious effects on anaesthetized patients. This study aimed to evaluate the effectiveness of phenylephrine infusion in preventing perioperative shivering in patients undergoing lower segment cesarean section under spinal anesthesia and to observe the change in the patient's core temperature between the study and control groups.

METHODS

A total of 118 patients scheduled for elective lower segment cesarean section under spinal anesthesia were recruited for this prospective, double-blind, randomized controlled study. The patients were randomized into 2 groups with 59 patients per group. The phenylephrine Group received phenylephrine infusion at a rate of 0.5 mcg/kg/minutes, while the Control Group received normal saline at an equivalent rate. Systolic and diastolic blood pressure, heart rate, core temperature, and the presence and intensity of shivering were recorded before induction and every 15 minutes intraoperatively and postoperatively.

RESULTS

The incidence of intraoperative shivering was significantly lower in the Phenylephrine Group compared to control group (29.1% vs 47.5% respectively; P = .044). Postoperatively, the Phenylephrine Group also had a lower incidence of shivering (34.5% vs 42.4%), but the difference was not statistically significant (P value = 0.391). There were no significant differences in the intensity of shivering between the 2 groups perioperatively, as well as in the systolic and diastolic blood pressure and core temperature. The phenylephrine Group showed a significantly lower heart rate at 15, 30, and 45 minutes after spinal block (P value = .005, .000, and .008, respectively), and at 0 and 30 minutes (P value = .004 and .020 respectively) in the recovery room. There were no significant differences in perioperative adverse events such as hypotension, hypertension, and bradycardia.

CONCLUSION

Phenylephrine infusion reduces the incidence of perioperative shivering in lower segment cesarean sections under spinal anesthesia.

Phenylephrine Attenuates Intra-Operative Hypothermia during Spinal Anaesthesia

Inadvertent hypothermia is common during spinal anaesthesia. This study was based on the hypothesis that phenylephrine might attenuate core hypothermia by inhibiting core-to-peripheral redistribution of body heat during spinal anaesthesia. In this prospective randomized study, 20 patients who underwent elective orthopaedic surgery under spinal anaesthesia were randomly assigned to receive either normal saline (control group) or continuously-infused phenylephrine 0.5 μg/kg per min (phenylephrine group). Core temperature, heart rate (HR) and mean arterial pressure (MAP) were monitored. Mean ± SE core temperature at the end of surgery was significantly higher in the phenylephrine-treated group compared with the control group (35.9 ± 0.1 °C versus 35.0 ± 0.1 °C, respectively), although there was no significant difference in baseline core temperature (both groups 36.3 ± 0.1 °C). Mean HR and MAP were not significantly different between the two groups. In conclusion, continuously-infused phenylephrine attenuated core hypothermia during spinal anaesthesia without any haemodynamic complications.

Rewarming rates and thermogenesis in hibernating echidnas

We measured body temperatures (T(b)) in 14 free-ranging echidnas (Tachyglossus aculeatus) using implanted data-loggers. An average of 1020+/-744 days of T(b) data was recorded from each animal. The average maximum T(b) was 35.3+/-0.7 degrees C (n=14), and the lowest T(b) was 4.7 degrees C. Detailed analysis of rewarming events from four echidnas showed rewarming time to be dependent on initial T(b) (rewarming time in hours=15.6-0.41T(initial), n=31) with an average rewarming rate of 1.9+/-0.4 degrees C h(-1). Based on an hourly sampling rate, the peak rewarming rate was found to be 7.2+/-0.8 degrees C h(-1) (n=12), which was measured at a mean T(b) of 26.2+/-2.4 degrees C. This rate of heating was calculated to be equivalent to a peak oxygen consumption rate of 1.4+/-0.2 ml O2 g h(-1), approximately 9 times the basal metabolic rate. We found that a plot of rate of change of T(b) against T(b) for the entire data set from an individual echidna provided a useful summary and analytical tool.