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Differential Roles of the Right and Left Toe Perfusion Index in Predicting the Incidence of Postspinal Hypotension During Cesarean Delivery.
Anesth Analg. 2017 11; 125(5):1560-1566.A&A

Abstract

BACKGROUND

Aortocaval compression by the gravid uterus, low baseline vasomotor tone, and spinal anesthesia-related sympathetic blockade contribute to spinal anesthesia-induced hypotension during cesarean delivery. The finger perfusion index (PI) can predict spinal hypotension by reflecting baseline vasomotor tone, but cannot directly reflect aortocaval compression by the gravid uterus. This study aimed to examine whether baseline toe PIs predict the incidence of maternal hypotension and reflect aortocaval compression by the gravid uterus during cesarean delivery under spinal anesthesia.

METHODS

One hundred parturients undergoing elective cesarean delivery were enrolled. The relationship between baseline toe PI and the incidence of hypotension after induction of spinal anesthesia was quantified using area under the receiver operator curves, and results compared for the right and left toe PIs.

RESULTS

The area under the receiver operator curves for left and right toe baseline PIs were 0.81 (95% confidence interval, 0.71-0.88) and 0.76 (95% confidence interval, 0.66-0.84), respectively. After induction of spinal anesthesia, the toe PIs did not change in parturients with hypotension, but increased significantly among those who did not develop hypotension.

CONCLUSIONS

Our study demonstrated that baseline toe PIs were inversely associated with the incidence of postspinal hypotension during cesarean delivery. Continuous monitoring of toe PIs during induction of spinal anesthesia might help to predict the development of postspinal hypotension and reflect the aortocaval compression by the gravid uterus.

Authors+Show Affiliations

From the *Department of Anesthesiology, the International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; and †Department of Anesthesiology & Pediatric Clinical Pharmacology Laboratory, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

28795968

Citation

Xu, Zifeng, et al. "Differential Roles of the Right and Left Toe Perfusion Index in Predicting the Incidence of Postspinal Hypotension During Cesarean Delivery." Anesthesia and Analgesia, vol. 125, no. 5, 2017, pp. 1560-1566.
Xu Z, Xu T, Zhao P, et al. Differential Roles of the Right and Left Toe Perfusion Index in Predicting the Incidence of Postspinal Hypotension During Cesarean Delivery. Anesth Analg. 2017;125(5):1560-1566.
Xu, Z., Xu, T., Zhao, P., Ma, R., Zhang, M., & Zheng, J. (2017). Differential Roles of the Right and Left Toe Perfusion Index in Predicting the Incidence of Postspinal Hypotension During Cesarean Delivery. Anesthesia and Analgesia, 125(5), 1560-1566. https://doi.org/10.1213/ANE.0000000000002393
Xu Z, et al. Differential Roles of the Right and Left Toe Perfusion Index in Predicting the Incidence of Postspinal Hypotension During Cesarean Delivery. Anesth Analg. 2017;125(5):1560-1566. PubMed PMID: 28795968.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Differential Roles of the Right and Left Toe Perfusion Index in Predicting the Incidence of Postspinal Hypotension During Cesarean Delivery. AU - Xu,Zifeng, AU - Xu,Tao, AU - Zhao,Puwen, AU - Ma,Rui, AU - Zhang,Mazhong, AU - Zheng,Jijian, PY - 2017/8/11/pubmed PY - 2017/10/31/medline PY - 2017/8/11/entrez SP - 1560 EP - 1566 JF - Anesthesia and analgesia JO - Anesth. Analg. VL - 125 IS - 5 N2 - BACKGROUND: Aortocaval compression by the gravid uterus, low baseline vasomotor tone, and spinal anesthesia-related sympathetic blockade contribute to spinal anesthesia-induced hypotension during cesarean delivery. The finger perfusion index (PI) can predict spinal hypotension by reflecting baseline vasomotor tone, but cannot directly reflect aortocaval compression by the gravid uterus. This study aimed to examine whether baseline toe PIs predict the incidence of maternal hypotension and reflect aortocaval compression by the gravid uterus during cesarean delivery under spinal anesthesia. METHODS: One hundred parturients undergoing elective cesarean delivery were enrolled. The relationship between baseline toe PI and the incidence of hypotension after induction of spinal anesthesia was quantified using area under the receiver operator curves, and results compared for the right and left toe PIs. RESULTS: The area under the receiver operator curves for left and right toe baseline PIs were 0.81 (95% confidence interval, 0.71-0.88) and 0.76 (95% confidence interval, 0.66-0.84), respectively. After induction of spinal anesthesia, the toe PIs did not change in parturients with hypotension, but increased significantly among those who did not develop hypotension. CONCLUSIONS: Our study demonstrated that baseline toe PIs were inversely associated with the incidence of postspinal hypotension during cesarean delivery. Continuous monitoring of toe PIs during induction of spinal anesthesia might help to predict the development of postspinal hypotension and reflect the aortocaval compression by the gravid uterus. SN - 1526-7598 UR - https://www.unboundmedicine.com/medline/citation/28795968/Differential_Roles_of_the_Right_and_Left_Toe_Perfusion_Index_in_Predicting_the_Incidence_of_Postspinal_Hypotension_During_Cesarean_Delivery_ L2 - http://dx.doi.org/10.1213/ANE.0000000000002393 DB - PRIME DP - Unbound Medicine ER -