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Intravenous Phenylephrine
Aka: Intravenous Phenylephrine, Intravenous Neo-Synephrine, Phenylephrine, Neo-Synephrine, Phenylephrine Push Dose Pressor
- See Also
- Septic Shock
- Intranasal Phenylephrine
- See Push Dose Pressor
- Indications: Hypotension (intravenous)
- Emergency Resuscitation for cardiovascular collapse while performing other interventions
- Example: Septic Shock refractory to fluid Resuscitation, temporizing while obtaining central access
- Can be used via peripheral IV for hours until central access is available for other pressors (e.g. Norepinephrine)
- Conscious Sedation
- Commonly used by anesthesiology for Hypotension secondary to Propofol and other agents
- Mechanism: Intravenous
- Direct selective alpha-Adrenergic Agonist
- Push Dose Pressor (Bolus Phenylephrine)
- Vasopressor without direct inotropic (contractility) or chronotropic (Heart Rate) activity
- Increases cardiac perfusion via Vasoconstriction and secondary increase in venous return
- Pharmacokinetics: Intravenous
- Onset: 1 minute
- Duration: 10-20 minutes
- Adverse Effects: Intravenous
- Local infiltration effects
- Less local toxicity to tissue and vascular structures compared with other pressors
- Reflex Bradycardia
- Unlikely in cardiovascular collapse in which adrenergic response is likely to be strong
- Baroreceptor reflex to increasing BP is typically outweighed by a stronger adrenergic response
- Preparation: Intravenous
- See Push Dose Pressor
- Dilute 1 ml (10 mg) from Phenylephrine vial (10 mg/ml) in Normal Saline 100 ml bag
- Resulting solution: Phenylephrine 100 mcg/ml
- Draw solution into labeled syringe for use as Push Dose Pressor
- Dosing: Intravenous
- Phenylephrine (100 mcg/ml) 50 to 200 mcg (0.5 to 2 ml) every 2-5 minutes
- Resources
- EM-Crit Blog (Scott Weingart)
- http://emcrit.org/podcasts/bolus-dose-pressors/
- http://emcrit/wp-content/uploads/push-dose-pressors.pdf
- NLM Daily Med
- http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=23174
- References
- Mattu and Weingart in Majoewsky (2013) EM:Rap 13(4): 9-10