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Perfusion index and hypotension during spinal anaesthesia for caesarean section

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Perfusion Index and Hypotension During Spinal

Anaesthesia for Caesarian Section L Hammon, I Wrench, S Handa*, R Mahajan*

Anaesthetic Department, Sheffield Teaching Hospitals NHS Foundation Trust, *Anaesthetic Department, Nottingham University Hospitals NHS Foundation Trust


Hypotension is common with spinal anaesthesia (SA) Caused by sympathetic block.1 Intermittent non-invasive blood pressure measurement (NIBPM) is standard

-may fail to detect episodes of hypotension in a timely fashion compared to a continuous NIBPM device.2

Previous work suggests a perfusion index (PI) of >3.5 predicts likelihood of hypotension during SA.3 No studies to guide early management of hypotension.

GOAL: Observational study to establish if PI (and pleth variability index (PVI*) could help prevent significant hypotension.

*variability of PI with respiratory cycle


19 patients for elective LSCS. Radical Seven® pulse oximeter (measures PI and PVI) and finometer (continuous NIBPM) attached prior to SA.


Following initiation of SA, PI values rose in 15 cases (and PVI fell in 13 cases)." On average PI values rose more rapidly for the ten patients who experienced hypotension (fall in systolic BP>25%) " Eight patients (no value for one) who did not become hypotensive had initial PI readings of <3.5

-Only three out of the ten who did become hypotensive had initial PI values of <3.5 (sensitivity 70%, specificity 100%).


Timing and degree of change in PI and PVI varied widely between patients. It did not demonstrate potential to inform management of blood pressure. High PI pre-SA may predict the occurrence of hypotension. PI appeared to increase higher and more quickly in women with significant hypotension

-suggests SA may have developed more quickly in these cases.

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