In Reply:-We appreciate Sibell's interest in our study “Treatment of hypotension after hyperbaric tetracaine spinal anesthesia: A randomized, double-blind, cross-over comparison of phenylephrine and epinephrine.” Although there were no adverse outcomes in this study, we described two patients with significant adverse events during treatment with phenylephrine. These two patients developed severe bradycardia during treatment of postspinal hypotension with phenylephrine, requiring rescue therapy with epinephrine when atropine failed to reverse the bradycardia. We agree with Sibell that agents such as epinephrine with potent inotropic and chronotropic activity may be more suitable therapy for management of hypotension after spinal block. It is our belief that the results of our study and the closed-claims study done by Caplan et al. support this conclusion.

Robert F. Brooker, M.D.

Assistant Professor; Department of Anesthesiology; Bowman Gray School of Medicine; Winston-Salem, North Carolina 27157–1009

(Accepted for publication July 7, 1997.)

Caplan RA, Ward RJ, Posner K, Cheney FW: Unexpected cardiac arrest during spinal anesthesia: A closed claims analysis of predisposing factors. Anesthesiology 1988; 68:5-11.