Background

Spinal anesthesia (SA) remains the most popular anesthetic technique for caesarean sections (CS), as it abolishes the possible risks of pregnant airway management. The ability to anticipate the episodes of hypotension following spinal anesthesia will enable anesthesiologists to interfere early and provide better patient management.

Objective

The aim of the current study was toevaluate the perfusion index and the blood pressure positional changes in the prediction of hypotension after SA in CSs.

Patients and methods

A prospective cohort study was conducted at the Obstetrics and Gynecology Department of Zagazig University Hospitals. A total of 80 pregnant women who were prepared for elective CS delivery, aged from 18 to 40 years with ASA-II (American Society of Anesthesiologists Status), were recruited in the current study.

Results

The mean perfusion index (PI) pre-spinal was 5.81 and immediately after spinal was 4.65 with a statistically significant decrease (P<0.001). There was also a statistical difference between the mean of mean arterial pressure (MAP) of the studied cases pre-spinal at the lateral position (91.76 mmHg) and mean MAP in the supine position (83.29 mmHg) with P-value <0.001, with a mean difference of 8.48 mmHg. PI cut-off >4 had a sensitivity of 85.9%, specificity of 75%, and accuracy of 83.8% in the prediction of hypotension. The positional change in blood pressure at cut-/off >5 mmHg had a sensitivity of 82.8%, specificity of 75%, and accuracy of 81.3% in the prediction of hypotension among cases.

Conclusion

The preoperative PI and positional blood pressure change can predict spinal anesthesia 

Abstract

Anaesthesia team should guarantee the patient safety first. To achieve this, it is necessary to be aware of both the anesthetic methods and all potential perioperative physiological changes). Spinal anaesthesia (SA) is the most preferred anesthetic method in caesarean deliveries because it eliminates the potential risks associated with airway management in pregnant women However, SA leads to hypotension in approximately 70% of patients Aortocaval compression caused by the uterus and a decrease in systemic vascular resistance due to sympathetic block induced by SA are important factors in the precipitation of hypotension. Hypotension following SA may cause dizziness, nausea, and vomiting in the mother, as well as fetal acidosis. Pregnant women are more sensitive to local anesthetics, less responsive to vasopressors and have lower mean arterial pressure (MAP) at term.