Evaluation of perfusion index to predict hypotension in lower segment caesarean section under spinal anaesthesia

Authors

  • Dr. Abiral Department of Anesthesia and Intensive Care Vardhman Mahavir Medical College & Safdarjung Hospital, Guru Gobind Singh Indraprastha University, New Delhi
  • Assoc. Prof. Dr. Dipendra Department of Public Health, School of Health and Allied Sciences, Pokhara University, Nepal
  • Mr. Subodh Department of Health, Nepal Health Professional Council, Nepal
  • Dr. Ayushi Public Health Administration Division, NHSRC Ministry of Health and Family Welfare, GoI
  • Asst. Prof. Sushila Department of Public Health, School of Health and Allied Sciences, Pokhara University, Nepal
  • Mr. Rajesh Department of Global Fund, Save the Children, Nepal

DOI:

https://doi.org/10.62992/9thgqn07

Keywords:

Caesarean section, Hypotension, Perfusion index, Spinal anaesthesia

Abstract

Background: Spinal Anaesthesia is the most popular choice for elective caesarean section. Both general anaesthesia and regional anaesthesia are acceptable techniques for anaesthesia for elective and emergency caesarean sections.

Objectives: The study aimed to investigate the role of the perfusion index in predicting the incidence of hypotension following spinal anaesthesia in parturients undergoing elective lower segment caesarean sections.

Methods: A prospective, observational study was carried out among sixty parturients posted for elective caesarean section. The study was conducted in the operation theatres of Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi. About 60 participants were interviewed for the study. Data were entered and analysed with the help of the Statistical Package for Social Science (SPSS) version.16.                                                                             

Results: Sixty eligible ASAI (American society of anaesthesiologist’s physical status classification) parturients scheduled for elective caesarean section were divided into two groups pre-operatively after determining their baseline Perfusion Index (PI) as those with PI ≤ 3.5 and those with PI > 3.5 using a Masimo® pulse oximeter probe. When comparing the heart rate at time intervals among the two groups, it became increasingly clear that those with baseline PI > 3.5 had generally higher heart rate especially immediately after the block and at 2nd, 4th, 6th,8th, 10th, 12th, 14th and 20th minutes.

Conclusion: The study concludes that a Perfusion Index > 3.5 is associated with a higher incidence of hypotension in lower segment caesarean section under spinal anaesthesia. The hemodynamic parameters such as increased heart rate and significantly lower systolic, diastolic and mean arterial pressures in parturients with baseline PI > 3.5 suggest that these patients have lower baseline SVR and depleted autonomic resilience to hypotension compared to those with baseline PI ≤ 3.5. High BMI seems to be significantly associated with high baseline PI.

References

Fitzgerald JP, Fedoruk KA, Jadin SM, Carvalho B, Halpern SH. Prevention of hypotension after spinal anaesthesia for caesarean section: a systematic review and network meta-analysis of randomised controlled trials. Anaesthesia. 2020;75(1):109-21.

Carter AM. Placental Gas Exchange and the Oxygen Supply to the Fetus. Comprehensive Physiology. 2015;5(3):1381-403.

Ueyama H, He Y-L, Tanigami H, Mashimo T, Yoshiya I. Effects of Crystalloid and Colloid Preload on Blood Volume in the Parturient Undergoing Spinal Anesthesia for Elective Cesarean Section Anesthesiology. 1999;91(6):1571-.

Aya AGM, Mangin R, Vialles N, Ferrer JM, Robert C, Ripart J, et al. Patients with severe preeclampsia experience less hypotension during spinal anesthesia for elective cesarean delivery than healthy parturients: a prospective cohort comparison. Anesthesia and analgesia. 2003;97(3):867-72.

Ajne G, Ahlborg G, Wolff K, Nisell H. Contribution of endogenous endothelin-1 to basal vascular tone during normal pregnancy and preeclampsia. Am J Obstet Gynecol. 2005;193(1):234-40.

Berlac PA, Rasmussen YH. Per-operative cerebral near-infrared spectroscopy (NIRS) predicts maternal hypotension during elective caesarean delivery in spinal anaesthesia. Int J Obstet Anesth. 2005;14(1):26-31.

Toyama S, Kakumoto M, Morioka M, Matsuoka K, Omatsu H, Tagaito Y, et al. Perfusion index derived from a pulse oximeter can predict the incidence of hypotension during spinal anaesthesia for Caesarean delivery. British journal of anaesthesia. 2013;111(2):235-41.

Brenck F, Hartmann B, Katzer C, Obaid R, Brüggmann D, Benson M, et al. Hypotension after spinal anesthesia for cesarean section: identification of risk factors using an anesthesia information management system. Journal of clinical monitoring and computing. 2009;23(2):85-92.

Ngan Kee WD, Khaw KS. Vasopressors in obstetrics: what should we be using? Current opinion in anaesthesiology. 2006;19(3):238-43.

Teoh WH, Sia AT. Colloid preload versus coload for spinal anesthesia for cesarean delivery: the effects on maternal cardiac output. Anesthesia and analgesia. 2009;108(5):1592-8.

Matsota P, Karakosta A, Pandazi A, Niokou D, Christodoulaki K, Kostopanagiotou G. The effect of 0.5 L 6% hydroxyethyl starch 130/0.42 versus 1 L Ringer's lactate preload on the hemodynamic status of parturients undergoing spinal anesthesia for elective cesarean delivery using arterial pulse contour analysis. Journal of anesthesia. 2015;29(3):352-9.

Singh Y, Anand RK, Gupta S, Chowdhury SR, Maitra S, Baidya DK, et al. Role of IVC collapsibility index to predict post spinal hypotension in pregnant women undergoing caesarean section. An observational trial. Saudi journal of anaesthesia. 2019;13(4):312-7.

Reuter DA, Felbinger TW, Schmidt C, Kilger E, Goedje O, Lamm P, et al. Stroke volume variations for assessment of cardiac responsiveness to volume loading in mechanically ventilated patients after cardiac surgery. Intensive care medicine. 2002;28(4):392-8.

Renner J, Gruenewald M, Quaden R, Hanss R, Meybohm P, Steinfath M, et al. Influence of increased intra-abdominal pressure on fluid responsiveness predicted by pulse pressure variation and stroke volume variation in a porcine model. Critical care medicine. 2009;37(2):650-8.

Natalini G, Rosano A, Taranto M, Faggian B, Vittorielli E, Bernardini A. Arterial versus plethysmographic dynamic indices to test responsiveness for testing fluid administration in hypotensive patients: a clinical trial. Anesthesia and analgesia. 2006;103(6):1478-84.

Sun S, Huang SQ. Role of pleth variability index for predicting hypotension after spinal anesthesia for cesarean section. Int J Obstet Anesth. 2014;23(4):324-9.

Smith RP, Argod J, Pépin JL, Lévy PA. Pulse transit time: an appraisal of potential clinical applications. Thorax. 1999;54(5):452-7.

Chamchad D, Arkoosh VA, Horrow JC, Buxbaum JL, Izrailtyan I, Nakhamchik L, et al. Using heart rate variability to stratify risk of obstetric patients undergoing spinal anesthesia. Anesthesia and analgesia. 2004;99(6):1818-21.

Hanss R, Bein B, Ledowski T, Lehmkuhl M, Ohnesorge H, Scherkl W, et al. Heart rate variability predicts severe hypotension after spinal anesthesia for elective cesarean delivery. Anesthesiology. 2005;102(6):1086-93.

Shibao C, Biaggioni I. Orthostatic hypotension and cardiovascular risk. Hypertension (Dallas, Tex : 1979). 2010;56(6):1042-4.

Frölich MA, Caton D. Baseline heart rate may predict hypotension after spinal anesthesia in prehydrated obstetrical patients. Canadian journal of anaesthesia = Journal canadien d'anesthesie. 2002;49(2):185-9.

M. C. Joshi KR, G. Rajaram, N. Nikhil, Shishir Kumar, Anuj Singh. Baseline heart rate as a predictor of post-spinal hypotension in patients undergoing a caesarean section: An observational study. bstet Anaesth Crit Care. 2018;8(20).

Duggappa DR, Lokesh M, Dixit A, Paul R, Raghavendra Rao RS, Prabha P. Perfusion index as a predictor of hypotension following spinal anaesthesia in lower segment caesarean section. Indian journal of anaesthesia. 2017;61(8):649-54.

Soma-Pillay P, Nelson-Piercy C, Tolppanen H, Mebazaa A. Physiological changes in pregnancy. Cardiovascular journal of Africa. 2016;27(2):89-94.

Ueki N, Takeda S, Koya D, Kanasaki K. The relevance of the Renin-Angiotensin system in the development of drugs to combat preeclampsia. Int J Endocrinol. 2015;2015:572713.

Sakai K, Imaizumi T, Maeda H, Nagata H, Tsukimori K, Takeshita A, et al. Venous distensibility during pregnancy. Comparisons between normal pregnancy and preeclampsia. Hypertension (Dallas, Tex : 1979). 1994;24(4):461-6.

Vinayagam D, Thilaganathan B, Stirrup O, Mantovani E, Khalil A. Maternal hemodynamics in normal pregnancy: reference ranges and role of maternal characteristics. Ultrasound Obstet Gynecol. 2018;51(5):665-71.

Mowafi HA, Ismail SA, Shafi MA, Al-Ghamdi AA. The efficacy of perfusion index as an indicator for intravascular injection of epinephrine-containing epidural test dose in propofol-anesthetized adults. Anesthesia and analgesia. 2009;108(2):549-53.

Ginosar Y, Weiniger CF, Meroz Y, Kurz V, Bdolah-Abram T, Babchenko A, et al. Pulse oximeter perfusion index as an early indicator of sympathectomy after epidural anesthesia. Acta anaesthesiologica Scandinavica. 2009;53(8):1018-26.

Yokose M, Mihara T, Sugawara Y, Goto T. The predictive ability of non-invasive haemodynamic parameters for hypotension during caesarean section: a prospective observational study. Anaesthesia. 2015;70(5):555-62.

Harten JM, Boyne I, Hannah P, Varveris D, Brown A. Effects of a height and weight adjusted dose of local anaesthetic for spinal anaesthesia for elective Caesarean section. Anaesthesia. 2005;60(4):348-53.

Nagraj A, Gupta P, Sahni A. Comparison of spinal block characteristics on height and weight based dosage versus fixed dosage of intrathecal bupivacaine for elective caesarean section. Sri Lankan Journal of Anaesthesiology. 2017.

De Felice C, Leoni L, Tommasini E, Tonni G, Toti P, Del Vecchio A, et al. Maternal pulse oximetry perfusion index as a predictor of early adverse respiratory neonatal outcome after elective cesarean delivery. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. 2008;9(2):203-8.

Daga SR, Kulkarni SK, Sharma AS, Verma BV. Umbilical venous blood gas analysis for neonatal assessment. Journal of pediatric intensive care. 2012;1(3):161-4.

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Published

17-09-2024 — Updated on 18-09-2024

How to Cite

1.
Evaluation of perfusion index to predict hypotension in lower segment caesarean section under spinal anaesthesia. IJPHAP [Internet]. 2024 Sep. 18 [cited 2025 Feb. 18];3(6):1-15. Available from: https://ijphap.com/index.php/home/article/view/75