Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jun 6;14(6):e25699.
doi: 10.7759/cureus.25699. eCollection 2022 Jun.

Peripheral Perfusion Index: A Predictor of Post-Spinal Hypotension in Caesarean Section

Nandini M G  1 , Madhu Srinivasaiah  1 , Jyosthna Prabhat K S  1 , Chaitra V  1 , Monica Kuradagi  1 , Reshma Mulla  1 , Venkatesh Murthy K T  1
Affiliations

Peripheral Perfusion Index: A Predictor of Post-Spinal Hypotension in Caesarean Section

Nandini M G et al. Cureus. .

Abstract

Background Early prediction of hypotension helps to decide appropriate prophylactic measures and, hence, safe anaesthesia for mothers and improved neonatal outcomes. Perfusion index (PI) measured from a standard pulse oximeter has shown positive results in the prediction of hypotension. This study aims to determine if PI can equally predict hypotension in parturients after administration of spinal anaesthesia at different time points. Methods Parturients posted for elective caesarean section belonging to the American Society of Anesthesiology II (ASA II) were divided into two groups based on baseline PI as group A <3.5 and group B ≥3.5. Fifty-six parturients were enrolled in the study. PI and blood pressure were monitored at baseline, every two minutes for 12 minutes and every five minutes until the end of the surgery, after administration of spinal anaesthesia with hyperbaric bupivacaine 10 mg. Incidence of hypotension was compared between groups at all time points of observation. Spearman's rank correlation coefficient was determined to check the correlation between baseline PI and the number of episodes of hypotension. Receiver operating characteristic (ROC) curve was plotted to determine the ideal cut-off at different time points. Results Baseline PI significantly correlated with the number of episodes of hypotension (r-0.525). The overall incidence of hypotension was significantly higher in parturients with baseline PI ≥3.5 (79.16%) as compared to those with PI <3.5 (33.33%). The incidence of hypotension at sixth, 10th and 37th minutes post-spinal anaesthesia administration was significantly higher in the group with PI ≥3.5. The sensitivity and specificity for the 3.5 cut-off of PI were 85.7% and 60%, respectively, at the 6th and 10th minute after spinal administration. A higher cut-off of 3.9 increases the specificity to 69% without much change in the sensitivity. Conclusion Parturients with PI >3.9 at baseline have a higher risk of hypotension in the initial 10-12 minutes following spinal anaesthesia during caesarean delivery.

Keywords: caesarean delivery; hypotension; perfusion index; pregnancy; spinal anaesthesia.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. CONSORT flow chart.
Figure 2
Figure 2. Change in systolic blood pressure at various time points.
Figure 3
Figure 3. ROC curves for the baseline PI and overall incidence of hypotension.
Diagonal segments are produced by ties ROC: Receiver operating characteristic; PI: Perfusion index.
Figure 4
Figure 4. ROC curves for the baseline PI and incidence of hypotension at the 6th minute (A) and 10th minute (B).
Diagonal segments are produced by ties. ROC: Receiver operating characteristic; PI: Perfusion index.
See this image and copyright information in PMC

References

    1. Regional versus general anesthesia for cesarean section delivery. Páez L JJ, Navarro JR. Rev Colomb Anestesiol. 2012;40:203–206.
    1. Venous distensibility during pregnancy. Comparisons between normal pregnancy and preeclampsia. Sakai K, Imaizumi T, Maeda H, Nagata H, Tsukimori K, Takeshita A, Nakano H. Hypertension. 1994;24:461–466. - PubMed
    1. Forearm blood flow in pre-eclampsia. Bowyer L, Brown MA, Jones M. Int J Obstet Gynec. 2003;110:383–391. - PubMed
    1. Contribution of endogenous endothelin-1 to basal vascular tone during normal pregnancy and preeclampsia. Ajne G, Ahlborg G, Wolff K, Nisell H. Am J Obstet Gynecol. 2005;193:234–240. - PubMed
    1. Sequential compression device with thigh-high sleeves supports mean arterial pressure during Caesarean section under spinal anaesthesia. Adsumelli RS, Steinberg ES, Schabel JE, Saunders TA, Poppers PJ. Br J Anaesth. 2003;91:695–698. - PubMed

LinkOut - more resources