Abstract
Introduction
Bolus-dose phenylephrine (BDPE) is routinely used to treat hypotension in the operating
room. BDPE's fast onset of action and ability to be administered peripherally have
prompted calls for its use in the Emergency Department (ED). There are few published
data on the safety of BDPE use in the ED. Primary concerns include BDPE's potential
to cause dangerous hypertension or reflex bradycardia. We hypothesize that BDPE is
a safe short-term vasopressor choice for hypotensive ED patients.
Methods
We conducted a structured chart review for all patients who received BDPE from preloaded
syringes over 42 months. We defined an adverse event (AE) as sBP > 180, dBP > 110, or HR < 50 within 30 min of receiving BDPE. We defined a serious adverse event (SAE) as an AE with pharmacologic
intervention to correct vital sign abnormality. We also compared mean arterial pressure
(MAP), sBP, and dBP pre/post BDPE administration to assess effectiveness. We used
a two-sample t-test to assess for differences between the mean delta MAP after low versus high-dose
BDPE.
Results
We identified 181 cases of ED use. 147 cases had complete pre/post vital signs. We
identified 5 AEs and no SAEs. Three patients developed sBP > 180 mm Hg. The patients suffered no apparent harm. No patients had dBP > 110. Two patients developed bradycardia post-drug. In both cases, MAP improved despite
bradycardia.
Conclusions
BDPE does not appear to cause reflex bradycardia or hypertension requiring intervention
among hypotensive ED patients. The apparent safety of BDPE should be confirmed in
prospective trials.
Keywords
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Article Info
Publication History
Published online: February 02, 2018
Accepted:
January 30,
2018
Received:
January 9,
2018
Footnotes
☆Meetings: An abstract entitled “Safety and Effectiveness of Bolus-Dose Phenylephrine for Hypotensive Emergency Department Patients” was presented at the Western Regional Society for Academic Emergency Medicine Conference in Los Angeles, California on April 2, 2016.
Identification
Copyright
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