Title: Pulse Oximeter- A Visionary to Augur Hypotension at a Glance- A Clinical Study Conducted in a Tertiary Care Institution in South India

Authors: Meenu Rajendran, Rajani Gandha Venkitachalam, Raman Naresh Kumar

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i5.73

Abstract

Background: Hypotension during spinal anesthesia for cesarian delivery is a result of decreased vascular resistance due to sympathetic blockade and decreased cardiac output due to pooling of blood in blocked areas of the body. Change in baseline peripheral vascular tone due to pregnancy may affect the degree of such hypotension. The perfusion index derived from pulse oximeter has been used for assessing peripheral perfusion dynamics due to changes in peripheral vascular tone.

Aim: To examine whether baseline perfusion index could predict the incidence of spinal anesthesia induced hypotension during caesarean delivery.

Methods: 154 pregnant females in the gestational age group 36-40 weeks who are undergoing elective cesarian delivery with no comorbidities have been enrolled in this study. We collected the data using structured proforma and interpreted using ROC analysis  to find optimal cut off value of baseline PI for prediction of hypotension

Results: Baseline PI correlated with the percentage decrease in mean arterial pressure (r=0.662;p=0.000). The cut-off PI value of 2.65 identified parturients at risk for spinal anaesthesia-induced hypotension with a sensitivity of 91.6%, specificity of 70.4%, positive predictive value of 78.4%, negative predictive value 87.7% and accuracy of 81.8%. Baseline PI correlated with no of episodes of hypotension and no of times vasopressors used (p<0.005). Percentage of decrease in MAP correlated with parturient height and baseline MAP(p < 0.05).

Conclusions: Baseline PI is associated with degree of hypotension after spinal anaesthesia for caesarean delivery. Baseline PI >2.65 can predict hypotension after spinal anaesthesia for caesarean delivery. 

Keywords: perfusion index; pulse oximeter; measuremet techniques, subarachnoid; complications.

References

  1. Ueyama H, He YL, Tanigami H, Mashimo T, Yoshiya I. Effects of crystalloid and colloid preload on blood volume in parturient undergoing spinal anesthesia for elective cesarean section. Anesthesiology 1999;91:1571–6
  2. Berlac PA, Rasmussen Per-operative cerebralnear-infrared spectroscopy (NIRS) predicts maternal hypotension during elective caesarean delivery in spinal anaesthesia. Int J Obstet Anesth 2005; 14:26–31
  3. Bonica JJ, Kennedy WF, Akamatsu TJ, Gerbershagen Circulatory effects of peridural block: 3. Effects of acute blood loss. Anesthesiology 1972;36:219–27
  4. Barwin BN, RoddieI C. Venous distensibility during pregnancy determined by graded venous Am J Obstet Gynecol 1976;125:921–3
  5. Ajne G, Ahlborg G, Wolff K, Nisell H. Contribution of endogenousendothelin-1 to basal vascular tone during normal pregnancy and Am J Obstet Gynecol 2005;193:234-40
  6. Adsumelli RS, Steinberg ES, Schabel JE, Saunders TA, Poppers Sequential compression device with thigh-high sleeves supports meanarterial pressure during Caesarean section under spinal anaesthesia. Br J Anaesth 2003;91:695–8
  7. Hales JR, Stephens FR, Fawcett AA, Observations on a new non-invasive monitor of skin blood flow. Clin Exp Pharmacol Physio l1989; 16:403–15
  8. 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. Anesth Analg 2009;108:549–53
  9. Ginosar Y, Weiniger CF, Meroz Y, et Pulseoximeter perfusion indexas an early indicator of sympathectomy after epidural anesthesia. Acta Anaesthesiol Scand 2009;53:1018–26
  10. Goldman JM, Petterson MT, Kopotic RJ, Barker SJ. Masimo signal extraction pulse Journal of Clinical Monitoring and Computing.2000;16:475-483.
  11. Hales JR, Stephens FR, Fawcett AA, et Observations on a new non-in vasive monitor of skin blood flow. Clinicaland Experimental Pharmacology and Physiology. 1989;16:403-415.
  12. Matsukawa T, Kurz A, Sessler DI, Bjorksten AR, Merrifield B, Cheng Propofollin early reduces the vaso constriction and shivering thresholds. Anesthesiology. 1995;82:1169-1180.
  13. Hager H, Reddy D, Kurz Perfusion index-a valuable tool to assess changes in peripheral perfusion caused by sevoflurane? Anesthesiology.2003;99:A593.
  14. Hagar H, Church S, Mandadi G, Pulley D, Kurz The perfusion index measured by a pulseoximeter indicates pain stimuli in anesthetized volunteers. Anesthesiology. 2004;101:A514.
  15. Kakazu CZ, Chen BJ, Kwan Masimoset technology using perfusion index is a sensitive indicator for epidural onset. Anesthesiology. 2005;103:A576.
  16. Uemura A, Yagihara M, Miyabe M. Pulseoxymeter perfusion index as a predictor for the effect of pediatric epidura l Anesthesiology.2006;105:A1354.
  17. Genzel-Boroviczeny O, Strotgen J, Harris AG, Messmer K, Christ Orthogonal polarization spectral imaging (OPS): a novel method to measure the micro circulationinterm and preterm infants transcutaneously. Pediatric Research. 2002;51:386-391.
  18. De Felice C, Latini G, Vacca P, Kopotic RJ. The pulseoximeter perfusion index as a predictor for high illness severity in European Journal of Pediatric Medicine. 2002;161:561-562.
  19. Hanns R, Bein B, Ledowski T,et Heartratevari ability predicts severe hypotension after spinal anesthesia for elective cesarean delivery. Anesthesiology 2005;102:1086–9
  20. Aya AG, Mangin R, Vialles N, etal. Patients with severe preeclampsia experience less hypotension during spinal anesthesia for elective cesarean delivery than healthy parturients: a prospective cohort comparison. Anesth Analg 2003;97:867–72

Corresponding Author

Rajani Gandha Venkitachalam

Associate Professor, Department of Anaesthesia

Govt. Medical College Thiruvananthapuram, Kerala, India

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.