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Category: Volume 06 Issue 05 May 2018
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Title: Perfusion Index Assessed from a Pulse Oximeter as a Predictor of Hypotension during Spinal Anaesthesia for Caesarean Section

Author: Dr Regimol V Varghese

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i5.68

Abstract

Background and Aims: Hypotension during spinal anaesthesia for caesarean section is a common and important problem with foetal and maternal implications. Perfusion Index (PI) observes from a pulse oximeter has been used for assessing peripheral perfusion dynamics due to changes in peripheral vascular tone. The aim of this study was to determine whether a baseline PI can predict hypotension after spinal anaesthesia for caesarean section.

Methods: In this prospective observational study, 60 pregnant women were divided into two groups on the basis of PI. Group 1 included those with PI > 3.5 and group II, those with PI£3.5. Spinal anaesthesia was given with 2ml of 0.5% bupivacaine (hyperbaric) in L3-L4 or L2-L3 inter space. A mean arterial pressure (MAP) of < 65mm of Hg is defined as hypotension. Statistical analysis was performed using independent sample t-test and chi-square test. Receiver operating characteristic (ROC) curve was plotted for PI and occurrence of hypotension. 

Results: The incidence of hypotension is 86.67% in group I whereas it is 6.67% in group II. The correlation between baseline PI>3.5 and the number of episodes of hypotension and the dose of vasopressors was also significant. The sensitivity and specificity of baseline PI of 3.5 to predict hypotension was 86.67% and 93.33% respectively. The area under the ROC curve for PI to predict hypotension was 0.911.

Conclusion: The incidence of hypotension following spinal anaesthesia for caesarean section is high in parturient with baseline PI>3.5.

Keywords: Perfusion index, spinal anaesthesia, hypotension, pregnancy

References

  1. David G Bishop. Hypotension under spinal anaesthesia for caesarean section remains common problem .South African Journal of Anaesthesia and Analgesic. 2014;20:170-174.
  2. Hanss R Bein B, Francksen H etal Heart rate variability guided prophylactic treatment of severe hypotension after SAB for elective C S.Anaesthology 2006;104; 635-43.
  3. Yokose M, Mihara T. Sugavara Y, GotoT.The predictive ability of non invasive hemodyn-amic parameter of hypotension during C.S.: a prospective observational study. Anaesthesia 2015;70:555-62
  4. Lima AP, Beleen P, Bakker J. Use of a peripheral perfusion index derived from the pulse oximetry signal as a non invasive indicator of perfusion. Critcare med 2002;30:1210-3.
  5. Hales JR, Stephen FR, Fawcett AA, Daniel K, Sheahan J et al. Observations on a new non-invasive monitor of skin blood flow-Clin,Exp.Pharmacolphysiol 1989;16:403-15
  6. Sun S Huang AQ. Role of pleth variability index for predicting hypotension after spinal anesthesia for caesarean section. International journal ofobsteric Anesthesia 2014;23:324-9.
  7. Ginosar Y, Weiniger C F, Merozy et al . Pulse oximeter perfusion index as an early detector of sympathectomy after epidural anaesthesia. Acta Anaesthesiol Scand:2009; 53:1018-23.
  8. Toyama S, Kakumoto M, Morioka M et al. Perfusion index derived from a pulse oximeter can predict the incidence of hypotension during spinal anaesthsia for caesarean delivery. BJA 2013;111:235-41
  9. Ledowski T, Paech M J, Browning R, Prenss J, Schug SA. An observational study of skin conductance monitoring as a means of predicting hypotension from sp. Anesth for caesarean delivery. Int.JObstctAnesth 2010;19:282-6.
  10. Clapp JF 3rd, Capeless E cardiovascular function before, during and after first and subsequent pregnancies. Am J Cardiol1997;80:1469-73.
  11. Devika Rani Duggappa, MPS Lokesh, Aanchal Dixit, Rinita Paul et al Perfusion index as a predictor of hypotension following spinal anesthesia in lower segment caesarean section      Indian Journal of Anesthesia 2017;61;649-54
  12. Mowali H A , Ismail SA, Shafi MA,Al. Ghandhi AA. The efficacy of profusion index as an indicator for intravascular injection of epinephrine containing epidural test done in propotol anaesthtised adults. Anesth. Analog.2009;108:548-53.
  13. Broch O, Bein B. Gruenewald M, etal. Accuracy of the pleth variability index to predict fluid responsiveness depends on the perfusion index. Acta Anaesthesiol Scaned. 2011,55:686-93.
  14. Sukumara H Ohashi Y, Swanki Y, KodoY –Sakai H. Perfusion index via fingers and toe during caesareaan section by Spanaesthesia. Anesthesiology 2008;109 A587
  15. Park GE Hauch MA, Curlin F, Dutta S, Bader AM. The effects of varying volumes of crystalloid administration before caesarean delivery on maternal haemodyn-amics and colloid osmotic pressure. Anesth.Analg 1996;83: 299-303.
  16. Ajne G, Aliborg G, Wolff K, Nissel H. Contribution of endogenous endothelium-1 to basal vascular tone during normal pregnancy and preeclampsia. Am.J.Obstret Gynecol 2005;193:234-40

Corresponding Author

Dr Regimol V Varghese                        

Assistant Professor in Anaesthesiology, Govt Medical College, Kottayam, India

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