P-21: Assessing the current practices and opinions of anesthesiologists in the Kitchener-Waterloo-Cambridge area regarding intraoperative phenylephrine administration during elective cesarean sections
Yu J*, Puopolo L, Latchford K
Introduction: The ideal regimen for phenylephrine administration during cesarean sections has long been disputed. Some studies show phenylephrine infusions can lead to more stable maternal hemodynamics and decreased rates of post-operative nausea and vomiting (PONV), whereas others show no differences between phenylephrine infusions and boluses. Our objective is to assess current practices and opinions of local anesthesiologists regarding phenylephrine administration (either as an infusion or a bolus) during elective cesarean sections.
Methods: A survey assessing practices and opinions regarding phenylephrine administration was distributed to anesthesiologists at Grand River Hospital (GRH) and Cambridge Memorial Hospital (CMH) from September â€“ December 2016.
Results: 12/20 and 9/12 anesthesiologists from GRH and CMH completed the survey, respectively. We found that 85.7% prefer to administer phenylephrine as a bolus. In terms of safety, 71.4% feel that both methods are equally safe, while 28.6% feel that infusions are safer. We also found that 95.2% feel that boluses take less time and effort, and 71.4% feel that infusions are costlier. When assessing other clinical outcomes, 81% feel that infusions would lead to more stable maternal blood pressures, and 61.9% feel that they are equal in terms of PONV.
Conclusions: While most respondents prefer to administer phenylephrine as a bolus rather than an infusion, many feel that both methods are equal in terms of safety and rates of PONV, and that infusions would lead to more stable maternal hemodynamics. Despite this, perceived increases in time, effort, and cost are significant barriers to local anesthesiologists utilizing phenylephrine infusions more often.