Utility of the Pleth Variability Index in predicting anesthesia-induced hypotension in geriatric patients

Abstract

The utility of the pleth variability index in predicting anesthesia-induced hypotension in geriatric patients Abstract Background/aim: Anesthesia induced hypotension may have negative consequences in geriatric patients. Therefore, predicting hypotension remains an important topic for anesthesiologists. Pleth Variability Index (PVI) measurement provides information about the fluid status and vascular tonus of the patients. In our study, the ability of Pleth Variability Index to predict hypotension after general anesthesia induction was evaluated. Materials and methods: PVI values obtained from pulse oximetry were recorded in addition to preoperative standard anesthesia monitoring. The correlation between the PVI value and mean arterial pressure (MAP), systolic arterial blood pressure (SAP) changes and the power of PVI values to predict the incidence of hypotension after anesthesia induction (>20% MAP decrease) was tested. Results: Eighty patients over 65 years of age who were operated under general anesthesia were included in the study. Hypotension was observed in 20 patients (25%). PVI values were mild and positively correlated with MAP changes (r = 0.195 and p=0.041). According to the ROC analysis, the incidence of hypotension increased in patients with PVI values above 15.45%. We also found the following diagnostic results for PVI value for predicting hypotension: p=0.044 and Area Under ROC Curve 0.651 ± 0.073 (95%, Confidence Interval: CI 0.507-0.794), Sensitivity of 40%, specificity of 80%, PPV of 40%, NPV of 80%, cutoff value of 15.45, positive likehood ratio of 2, negative likehood ratio of 0.75, Youden Index of 0.2. 2 Conclusion: Predicting hypotension in geriatric patients is an important issue for anesthesiologists. As an easily applicable test, The Pleth Variability Index is useful in predicting MAP reduction in patients. This practical technique can be used routinely in all geriatric patient groups.

The Use of Oxygen Reserve Index in One-Lung Ventilation and Its Impact On Peripheral Oxygen Saturation, Perfusion Index and Pleth Variability Index

“…[13][14][15][16] ORi is a parameter-driven from this device that is between 0 and 1 values, and it is sensitive to the changes in arterial oxygenation in the blood, with the range of 100 to 200 mmHg. [2,[8][9][10]13,[18][19][20][21] When oxygenation is in the moderate hyperoxic content showing an arterial blood oxygenation value of 100-240 mmHg in arterial blood gas analysis, the pulse oximeter SpO2 value remains 100%, whereas there is a decrease in the value of ORi. [2,[18][19][20][21] In our study, Figure 1 and Table 4 provides data on timedependent correlations between ORi with SpO2.…”

“…This study shows that ORi has a signi cant correlation with PaO2 (r = 0.671, p < 0.01). [18] In other studies, a continuous correlation between ORi and PaO2 values was demonstrated [13][14][15][19][20][21]…”

“…All patients received lactated Ringer's solution infusion. [5,13] Hypoxemia during OLV was de ned as a SpO2 value of less than 95% when the FiO2 value is equal to or greater than 60% on a pulse oximetry device. [5,10] The anesthesiologist who conducts the anesthesia during surgery was responsible for increasing FiO2, using bag-mask ventilation of 100% for a while, implementing an alveolar recruitment maneuver, or using continuous positive airway pressure to the collapsed lung during a desaturation of SpO2 value less than 95%.…”

“…The incidence of thromboembolic complications, arrhythmia, pneumonia, the duration of hospital and intensive care unit stay were recorded. [9,13,[15][16][17][18] Intravenous ephedrine (Ephedrine, Osel Pharmaceutical, Turkey) at a dose of 10 mg bolus injections were considered if SBP was less than 90 mmHg. Hypotension was de ned as a decrease in MAP more signi cant than 20% after anesthesia induction and treated with intermittent bolus doses of 5 mg ephedrine.…”

“…The necessary closure related procedure, including necessary suturing, aspiration, and irrigation of uids and blood, are performed. [13,15,18] 2.5 The Ethical Considerations Trakya University Faculty of Medicine University Ethical Committee agreed and approved the study in February 2020. All patients approved the fully informed written consent to participate in the study.…”