To study the role of perfusion index as a predictor of hypotension during spinal anesthesia in lower segment cesarean section – A prospective observational study

Abstract

Background and Aims: Spinal anesthesia has become the choice of neuraxial anesthesia for cesarean delivery. Hypotension, the most common side effect of spinal anesthesia is more in parturients. Perfusion index (PI) is one of the newest methods, used noninvasively for the prediction of hypotension postspinal anesthesia, evaluation of regional block success, and a tool for pain assessment. In our study, we have used PI for predicting the occurrence of hypotension postsubarachnoid block in elective lower segment cesarean section (LSCS). Methods: In this prospective observational study, parturients posted for elective LSCS under spinal anesthesia were included. Spinal anesthesia was performed at L 3 -L 4 interspace using 25G (gauge) Quincke needle, with 1.8 mL of 0.5% hyperbaric bupivacaine plus 20 μg fentanyl. Hypotension was defined as a decrease in systolic blood pressure >25% from the baseline. Statistical Analysis Used: Statistical analysis was performed using the paired sample t -test, Chi-square test, and independent t -test. Results: From our study, we had found that a positive correlation exists between the baseline PI of the patient and the occurrence of hypotension intraoperatively. A cutoff value of 1.75 (with P < 0.001) was found to be significant; above which the occurrence of hypotension was definite. The sensitivity of this cutoff value was 75% and specificity was 71% for this value. Conclusion: Baseline perfusion of >1.75 can predict hypotension postspinal anesthesia in LSCS. The incidence of hypotension was about 93% in parturients whose baseline was above the cutoff value.

Predictive Efficacy of the Perfusion Index for Hypotension following Spinal Anesthesia in Parturient Undergoing Elective Cesarean Section: A Systematic Review and Meta-Analysis

“…Subsequently, a detailed examination of full-text articles resulted in the exclusion of 14 studies. Ultimately, 12 studies successfully satisfied the established criteria and were included in the review [15,17,18,[22][23][24][25][26][27][28][29][30]. The characteristics of the 11 studies involving 2009 patients are summarized in Table 1.…”

“…1. This meta-analysis included 12 studies conducted in various countries, including India (n = 7) [17,[22][23][24][25]27,29], Nepal (n = 2) [28,30], Japan (n = 1) [15], and China (n = 2) [18,26]. All studies focused on parturients who underwent elective cesarean section.…”

“…The number of patients enrolled in each study varied from 35 to 1071 participants. Among the 12 studies, 11 used bupivacaine (range: 9-15 mg) as the anesthetic agent for spinal anesthesia [15,17,[22][23][24][25][26][27][28][29][30], whereas one used ropivacaine (12 mg) [18]. The cutoff value for the performance index (PI) varied across studies, ranging from 1.75 to 5.845.…”

“…Regarding the risk of bias domains, all studies were rated as low-risk in terms of patient selection, reference standard, flow, and timing. However, three studies raised concerns regarding the index test domain [18,24,26]. Regarding applicability concerns, all studies were categorized as low-risk in the patient selection, index test, and reference standard domains.…”

Predictive ability of pulse oximetry-derived indices for hypotension after spinal anaesthesia for caesarean section: protocol for a systematic review and meta-analysis

“…PI is a measure of peripheral vascular tone and PVI is a measure of infusion responsiveness that reflects respiratory variability in PI 4 5. Although several studies have used these pulse oximetry-derived indices to predict hypotension after spinal anaesthesia, the predictive ability of these indices remain controversial 4 6–8…”