Title: The Variability of Perfusion Index as a New Parameter in Different Types of Anaesthesia Techniques and Its Correlation with Surgical Stress and Recovery From Anesthesia: An Observational Clinical Study
Authors: Dr Amit Kumar MD (Anesthesiology), Dr A.V. Nadkarni MD,D.A. (Anesthesiology)
DOI: https://dx.doi.org/10.18535/jmscr/v5i1.11
Abstract
INTRODUCTION
Perfusion index is an indirect, non invasive, numerical, dynamic and continuous measure of peripheral perfusion obtained from pulse oximeter that provides useful information to the physician in several clinical settings. Perfusion index is reliable and easier alternative for detection of stress response during induction59 and peri-operative period of operation and has a prognostic value in predicting peri-operative outcome.65
Trends in change of perfusion index reveals even the subtle changes in peripheral circulation that is otherwise missed in static display.
In anaesthetic settings spike in perfusion index indicates onset of anaesthesia at the physiological level and gives physicians one more tool to further consolidate onset of anaesthesia15,19,44,48,64.Peripheral Perfusion index alterations are more marked in patients who are likely to develope severe complications.Studies are also showing that treatment based on perfusion index can lead to improved patient outcome.
References
1. 1. Brian L. Partridge .Use of Pulse Oximetry as a Noninvasive Indicator of Intravascular Volume StatusJournal of Clinical Monitoring.1987; 3(4):263-268.
2. Evans ML, Geddes LA. An assessment of blood vessel vasoactivity using photoplethysmography.Med Instrum 1988; 22(5):29–32.
3. Hales JR, Stephens FR, Fawcett AA, Daniel K, Sheahan J, Westerman RA, James SB;Observations on a new non-invasive monitor of skin blood flow: ClinExpPharmacol Physiol. 1989 ;16(5):403-15
4. Bernardi L, Radaelli A, Solda PL, Coats AJ, Reeder M, Calciati A, Garrard CS, Sleight P.;Autonomic control of skin microvessels: assessment by power spectrum of photoplethysmographic waves.:ClinSci (Lond). 1996; 90(5):345-55.
5. ShamirM, EidelmanL.A., FlomanY, Kaplan L and PizovR;Pulse oximetryplethysmographic waveform during changes in blood volume:Br. J. Anaesth. (1999) 82 (2): 178-181.
6. Sinex, J.E. Pulse oximetry: principles and limitations. Am J Emerg Med. 1999; 17:59–67.
7. Kihara S, Brimacombe J, Yaguchi Y, Watanabe S, Taguchi N, Komatsuzaki T. Hemodynamic responses among three tracheal intubation devices in normotensive and hypertensive patients. AnesthAnalg 2003;96:890-5.
8. Shimoda O, Ikuta Y, Isayama S, Sakamoto M, Terasaki H. ;skin vasomotor reflex induced by laryngoscopy:compariso between Mc-coy and Macjntosh :British Journal of Anesthesia1997;84:120-126
9. Takahashi S, Tanaka M, Toyooka H. ;The efficacy of hemodynamic and T-wave criteria for detecting intravascular injection of epinephrine test dose in propofol-anesthetized adults:anesthAnalg. 2002 ;94(3):717-22;
10. Pole Y.Evolution of the pulse oximeter:International Congress Series the history of anaesthesia 2002;vol1242: 137–144.
11. Robert F. Tamburro, John C. Ring, Kimberly Womback; Detection of PulsusParadoxus Associated With Large Pericardial Effusions in Pediatric Patients by Analysis of the Pulse-Oximetry Waveform: Pediatrics, 2002; vol 109 ( 4);1-8
12. Barak M, Ziser A, Greenberg A, Lischinsky S, Rosenberg B.; Hemodynamic and catecholamine response to tracheal intubation: direct laryngoscopy compared with fiberoptic intubation: J ClinAnesth. 2003; 15(2):132-6.
13. Koppel R, Druschel CM, Carter T, Goldberg BE, Mehta PN, Talwar R, Bierman FZ. ;Effectiveness of pulse oximetry screening for congenital heart disease in asymptomatic newborns: Pediatrics. 2003; 111(3):451-5.
14. Hagar H, Church S, Mandadi G, Pulley D, Kurz A. The perfusion index measured by a pulse oximeter indicates pain stimuli in anesthetized volunteers. Anesthesiology 2004; 101:A514.
15. Kakazu CZ, Chen BJ, Kwan WF. Masimo set technology using perfusion index is a sensitive indicator for epidural onset. Anesthesiology. 2005;103:A576.
16. Surgical stress response BrJA. 2003;109;B672.
17. Lima AP, Beelen P, Bakker J. Use of a peripheral perfusion index derived from the pulse oximetry signal as a noninvasive indicator of perfusion. Crit Care Med 2002; 30:1210-3.
18. Takenaka M, Greenberg A, Lischinsky S, Rosenberg B.; Hemodynamic and catecholamine response to tracheal intubation: direct laryngoscopy compared with fiberoptic intubation: J ClinAnesth. 2003; 15(2):132-6.
19. Galvin EM, Niehof S, Verbrugge SJ, Maissan I, Jahn A, Klein J, van Bommel J.Periipheral flow index is a reliable and early indicator of regional block success.:AnesthAnalg. 2006 ;103(1):239-43,
20. Feissel M, Teboul JL, Merlani P, Badie J, Faller JP, Bendjelid K Plethysmographic dynamic indices predict fluid responsiveness in septic ventilated patients: Intensive Care Med. 2007 ;33(6):993-9.
21. Awad AA, Haddadin AS, Tantawy H, Badr TM, Stout RG, Silverman DG, Shelley KH;The relationship between the photoplethysmographic waveform and systemic vascular resistance :J ClinMonitComput. 2007; 21(6):365-72.
22. Allen j.Photoplethysmography and its application in clinical physiological measurement; Physiol Meas. 2007;28(3):R1-39:
23. AGranelli Ad, Ostman-Smith I. ; Noninvasive peripheral perfusion index as a possible tool for screening for critical left heart obstruction. ActaPaediatr. 2007 ;96(10):1455-9.
24. Severinghaus JW. Takuo Aoyagi: discovery of pulseoximetry :anesthAnalg. 2007; 105(6 Suppl):S1-6.
25. Shelley KH .Photoplethysmography: Beyond the Calculation of Arterial Oxygen Saturation and Heart Rate : AnesthAnalg 2007;105(6 suppl):S1-4
26. Gesquiere, M.J., Awad, A.A., Silverman, D.G. et al, Impact of withdrawal of 450 ml of blood on respiration-induced oscillations of the ear plethysmographic waveform. J ClinMonitComput. 2007;21(5):277–282.
27. Raamat R, Jagomägi K, Talts J. Calibrated ;photoplethysmographic estimation of digital pulse volume and arterial compliance: ClinPhysiolFunct Imaging. 2007 ;27(6):354-62.
28. Frey B, Waldvogel K, BalmerC;Clinical applications of photoplethysmography in paediatric intensive care.:intensive Care Med. 2008 ;34(3):578-82.
29. Mowafi HA, Arab SA, Ismail SA, Al-Ghamdi AA, Al-Metwalli RR ;Plethysmographic pulse wave amplitude is an effective indicator for intravascular injection of epinephrine-containing epidural test dose in sevoflurane-anesthetized pediatric patients.:AnesthAnalg. 2008;107(5):1536-41.
30. Landsverk SA, Hoiseth LO, Kvandal P, Hisdal J, Skare O, Kirkeboen KA. Poor agreement between respiratory variations in pulse oximetryphotoplethysmographic wave form amplitude and pulse pressure in intensive care unit patients.anesthesiology 2008;81:148-54
31. M. Koch, D. De Backer, J. L. Vincent, L. Barvais, D. Hennart and D. Schmartz1;Effects of propofol on human microcirculation:Br. J. Anaesth. 2008 101 (4): 473-478.
32. Li SQ, Luo BR, Wang BG; Correlation of tip perfusion index with hemodynamics and catecholamines in patients undergoing general anesthesia: Zhonghuayixuezazhi : 2008, 88(17):1177-1180
33. Reisner A, ShaltisPA, McCmbieD, Asada HH. Utility of the photoplethysmography in circulatory monitoring.Anesthesiology 2008;108:950-8
34. KorhonenA. and Yli-hankala.A. Photoplethysmography and nociception; Acta Anaesthesiologica Scandinavica: 2009:53( 8): 975–985,.
35. MustolaS, ParkkariT, HuikuM, KymäläinenM and ToivonenJ;Performance of Surgical Stress Index during Sevoflurane-Fentanyl and Isoflurane- Fentanyl Anesthesia: Anesthesiology Research and Practice 2010;1242; 1-5
36. CresiF, PelleE, CalabreseR, CostaL, FarinassoD and SilvestroL;Perfusion index variations in clinically and hemodynamically stable preterm newborns in the first week of life Italian Journal of Pediatrics 2010, 36(6) .43-49
37. Sandroni C etal; Accuracy of plethysmographic indices as predictors of fluid responsiveness in mechanically ventilated adults: A systematic review and meta-analysis:Intensive Care Medicine 2012; 38(9):1429-37.
38. Sahni R, Schulze KF, Ohira-Kist K, Kashyap S, Myers MM, Fifer WP.interactions among peripheral perfusion, cardiac activity, oxygen saturation, thermal profile and body position in growing low birth weight infants:ctaPaediatr. 2010;99(1):135-9.
39. Xinzhong C· KoheiGodai · Maiko Hasegawa-Moriyama · Tamotsu Kuniyoshi · Akira Matsunaga · Yuichi Kanmura · TomoyukiKuwaki;Perfusion index as a possible predictor for postanestheticshivering:Journal of Anesthesia2013; 28(1). 123-27
40. Donald H Arnold,,Cathy A Jenkins, and Tina V Hartert,Noninvasive assessment of asthma severity using pulse oximeterplethysmograph estimate of pulsusparadoxusphysiology:MCPulm Med. 2010; 10: 17.
41. Hood, Julian A.; Wilson, R. Jonathan T. ;Pleth Variability Index to Predict Fluid Responsiveness in Colorectal Surgery:Anesthesia&Analgesia:November 2011 - 113 ( 5) 1058–1063
42. Abdullah M et al;Goal directed fluid optimization using pleth variability index versus corrected flow time in cirrotic patients undergoing major abdominal surgery;Egyptian journal ;2011;28;23-28.
43. Bonhomme V, Uutela K, Hans G, Maquoi I, Born JD, Brichant JF, Lam;Comparison of the surgical Pleth Index™ with haemodynamic variables to assess nociception-anti-nociception balance during general anaesthesia.:Br J Anaesth. 2011;106(1):101-11.
44. DouglasE,Perfusion Index Used as Tool To Confirm Epidural Placement: Clinical Anesthesiology 2006 ; vol 32:06-45
45. Cannesson M, Desebbe O, Rosamel P, Delannoy B, Robin J, Bastien O, Lehot JJ.Pleth variability index to monitor the respiratory variations in the pulse oximeter plethysmographic waveform amplitude and predict fluid responsiveness in the operating theatre; Br J Anaesth. 2008;101(2):200-6.
46. Takeyamam,MatsunagaA,KakihanaY,MasudaM,KuniyoshiT,KanmuraY.Impact of skin incision on thePVI.J ClinComput2011;4(25):215-2
47. Mohamed Elgendi;On the Analysis of Fingertip Photoplethysmogram Signals: CurrCardiol Rev. 2012; 8(1): 14–25
48. Hajime Yamazaki, Junichi Nishiyama, and Toshiyasu Suzuki;Use of perfusion index from pulse oximetry to determine efficacy of stellate ganglion block:LocalRegAnesth. 2012; 5: 9–14.
49. J. Y. Yin andK. M. Ho2.Use of plethysmographic variability index derived from the Massimo® pulse oximeter to predict fluid or preload responsiveness: a systematic review and meta-analysisAnaesthesia: 2012 ;67(7): 777–783,
50. Hamunen K, Kontinen V, Hakala E, Talke P, Paloheimo M, Kalso E. Effect of pain on autonomic nervous system indices derived from photoplethysmography in healthy volunteers:Br J Anaesth. 2012;108(5):838-44.
51. Sahni R, Schulze KF, Ohira-Kist K, Kashyap S, Myers MM, Fifer WP.interactions among peripheral perfusion, cardiac activity, oxygen saturation, thermal profile and body position in growing low birth weight infants:ctaPaediatr. 2010 ;99(1):135-9.
52. Jung-Nam Kwon and Whan-Bong Lee ;Utility of digital pulse oximetry in the screening of lower extremity arterial disease: J Korean Surg Soc. 2012 ; 82(2): 94–100.
53. Toyama S, Kakumoto M, Morioka M, Matsuoka K, Omatsu H, Tagaito Y, Numai T, ShimoyamaM.;Perfusion index derived from a pulse oximeter can predict the incidence of hypotension during spinal anaesthesia for Caesarean delivery:. Br J Anaesth. 2013;111(2):235-41.
54. .Kinoshita M, Hawkes CP, Ryan CA, Dempsey EM. ;Perfusion index in the very preterm infant:ActaPaediatr. 2013 ;102(9):398-401.
55. Xu Z, Zhang J, Xia Y, Deng X. Accuracy of pulse oximeter perfusion index in thoracic epidural anesthesia under basal general anesthesia:Int J ClinExp Med. 2014 ;7(7):1728-34.
56. Zifengxu, Bartunek A, Gilly H.;Effect of local limb temperature on pulse oximetry and the plethysmographic pulse wave: Int J ClinMonitComput. 1997 ;14(1):17-22.
57. Kowalczyk M, FijałkowskaA, NestorowiczA ;New-generation pulse oximetry for the assessment of peripheral perfusion during general anaesthesia — a comparison between propofol and desflurane :AnaesthesiologyIntensive Therapy 2013, 45( 3) 134–144
58. van Genderen ME, Bartels SA, Lima A, Bezemer R, Ince C, Bakker J, van BommelJ.;Peripheral perfusion index as an early predictor for central hypovolemia in awake healthy volunteers.:AnesthAnalg. 2013;116(2):351-6.
59. Hosam M Atef, Salah Abd Fattah, Mohammed EmadAbdGaffer;Perfusion index versus non-invasive hemodynamic parameters during insertion of i-gel, classic laryngeal mask airway and endotracheal tube:ndian J Anaesth. 2013; 57(2): 156–162.
60. Chiharu Kuroki · KoheiGodai · Maiko Hasegawa-Moriyama · Tamotsu Kuniyoshi · Akira Matsunaga · Yuichi Kanmura · TomoyukiKuwaki;Perfusion index as a possible predictor for postanestheticshivering:Journal of Anesthesia ;2013; 28(1).176-186
61. NishimuraT, NakaeA, ShibataM, MashimoT,and FujinoY;Age-related and sex-related changes in perfusion index in response to noxious electrical stimulation in healthy subjects: J Pain Res. 2014; 7: 91–97.
62. Loupec T1, Nanadoumgar H, Frasca D, Petitpas F, Laksiri L, Baudouin D, Debaene B, Dahyot-Fizelier C, Mimoz O: Pleth variability index predicts fluid responsiveness in critically ill patients:Crit Care Med. 2011;39(2):294-9.
63. Hakan N, Dilli D, Zenciroglu A, Aydin M, OkumusN.;Reference values of perfusion indices in hemodynamically stable newborns during the early neonatal period:Eur J Pediatr. 2014 ;173(5):597-602.
64. IXu Z, Zhang J, Xia Y, Deng X. Accuracy of pulse oximeter perfusion index in thoracic epidural anesthesia under basal general anesthesia:Int J ClinExp Med. 2014 ;7(7):1728-34.
65. van Genderen ME, Bartels SA, Lima A, Bezemer R, Ince C, Bakker J, van BommelJ.;Peripheral perfusion index as an early predictor for central hypovolemia in awake healthy volunteers.:AnesthAnalg. 2013 ;116(2):351-6.
66. Jardim J, Rocha R, Silva G, Guimarães H. Peripheral perfusion index- reference range in healthy Portuguese term newborns. J PediatrNeonat Individual Med. 2014;3(1):312-317
67. Huai-wu He,Da-wei Liu Yun Long, and Xiao-ting Wang:The peripheral perfusion index and transcutaneous oxygen challenge test are predictive of mortality in septic patients after resuscitation rit Care. 2013; 17(3): R116.critical Care. 2013; 17(3): R116.
68. Mousa WF. ;Effect of hypercapnia on pleth variability index during stable propofol: Remifentanilanesthesia:Saudi J Anaesth. 2013 Jul;7(3):234-7.
69. SawadaaY, Tanaka G, Ken-ichi,Yamakosh Y; Normalized pulse volume (NPV) derived photo-plethysmographically as a more valid measure of the finger vascular tone :International Journal of Psychophysiology2001;41(1) ;1–10.
70. Fagrell B.Dynamics of skin microcirculation in humans: J CardiovascPharmacol. 1985;7 (Suppl 3):53-8.
