The role of phenylephrine in perioperative medicine

Phenylephrine is a synthetic, direct sympathomimetic agent that is mainly used to induce locoregional vasoconstriction. For this purpose, phenylephrine is contained in several decongestant nasal sprays [1] and mydriatics [2] in doses usually not exerting significant systemic cardiovascular effects. In 1976, oral phenylephrine was approved for non-prescription use as a decongestant by the Food and Drug Administration (FDA) [3]. In addition, local phenylephrine injection may be considered to treat regional hyperemia, e.g., in patients with priapism [4]. Intravenous phenylephrine represents an effective vasopressor in a variety of clinical indications, particularly including Cesarean section and cardiovascular surgery. This chapter summarizes the pharmacology of intravenous phenylephrine and clinical studies investigating its use in the perioperative setting and provides recommendations for perioperative use. © 2009 Springer-Verlag New York.