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School of Anesthesia


Anesthesiology | Medical Education | Nursing | Orthopedics


Background Hypotension (IOH) is a common risk factor associated with spinal anesthesia (SA), and can be detrimental to patients, especially the elderly.1 2 3 The treatment regimen for IOH after SA varies in the orthopedic population. However, the current research literature suggests that a prophylactic infusion of phenylephrine significantly reduces the number of episodes and duration of hypotension.1 This EBP project aims to report the incidence of hypotension after SA among orthopedic surgery patients and the utilization of a prophylactic infusion of phenylephrine at Providence Sacred Heart Medical Center (PSHMC) in Spokane, WA.

Methods • A retrospective, EBP project was conducted at PSHMC. • Permission was obtained by PSHMC Clinical Innovation and Research Council and deemed exempt from human subjects research by the Providence Health Care Institutional Review Board. • Patient data was securely extracted, deidentified, and stored in a HIPPA compliant REDCap database. • Inclusion criteria: Adult patients ≥ 18 years old who received SA for non-emergent orthopedic surgery. • Exclusions: Pediatric, obstetric, emergency surgery, and surgery lines other than orthopedic. • IOH outcome determined by absolute mean arterial pressure (MAP) thresholds, as described in Wesselink et al. (2018) systematic review.4 • Descriptive analyses were conducted to examine baseline demographics and IOH treatment regimens utilized at PSHMC. • Independent risk factors determined using binary logistic regression and time-to-event (MAP <60 >mmHg) analyses determined using the Kaplan-Meier estimator (α = 0.05).

Discussion In this observational study of 3,745 patients, we found that orthopedic patients at our institution who did not receive a prophylactic phenylephrine infusion following SA had significantly increased risk of MAP≥ 10 minutes (RR 3.42, 2.55- 4.62, p

Clinical Institute

Orthopedics & Sports Medicine







Conference / Event Name

AANA 2020 Virtual Congress


Virtual Conference

Prophylactic Phenylephrine Infusion to Mitigate Intraoperative Hypotension after Spinal Anesthesia among Orthopedic Patients