Perfusion Index as a Predictor of Hypotension Following Sub-arachnoid Block Among Patients Undergoing Lower Segment Caesarean Section

C-section is one of the commonly performed surgical procedures. During this surgical procedure the surgeon cuts into uterine cavity through abdominal wall and takes out the baby. This is done by by making the lower half body of the patient numb by injecting local anesthesia drugs into the space surrounding the spinal cord. This allows the mother to remain awake and immediately bond with the baby once it gets delivered. Also this technique provides effective pain relief both during and after the surgery. However like any other technique or drug it is associated with a number of side effects. The most important being fall in blood pressure. There are numerous ways to treat it. However if one is able to predict fall in blood pressure before administration of anesthetic technique one can easily prevent it. One of the recently discovered novel way to predict fall in blood pressure is Perfusion index which is calculated by Pulse oximeter. It is a device use to check amount of oxygen in blood and heart rate. Perfusion index refers to the total amount of blood present in the limbs of the person. Once we administer drug in the space surrounding the spinal cord the amount of blood in the limbs increases while the amount returning to heart decreases which ultimately results in less amount of blood being pumped out by heart resulting in fall in blood pressure. Therefore theoretically those individuals who have a high baseline Perfusion index will more likely to develop low blood pressure. This study aims to identify the cut off value of perfusion index to predict fall in blood pressure.

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Key information

Conditions

Hypotension Cardiovascular Diseases Hypotension on Induction Spinal Anesthetics Causing Adverse Effects in Therapeutic Use Vascular Diseases

Age range

18 year–50 year

Sex eligibility

Female

Study type

Observational

Primary location

Deparment of Anesthesia and Critical Care Medicine, Pakistan Institute of Medical Sciences

Islamabad, Federal, 44000, Pakistan

About this study

Spinal anesthesia is employed to provide excellent surgical conditions in case of C-Section. It is the anesthetic technique of choice among obstetric patients. However it is associated with sympathectomy which reduces the venous return and ultimately causes hypotension. This hypotension is mainly due to redistribution of blood volume to the peripheral compartment. Perfusion index which is measured by Pulse Oximetery is a ratio of pulsatile to non-pulsatile blood in the peripheral compartment of the body. As spinal anesthesia causes sympathectomy, peripheral blood volume increases. As a result perfusion index value should rise. This will then co-relate with hypotension. In simple terms those individuals who have a high baseline Perfusion index value will more likely to develop hypotension. This study aims to identify the baseline perfusion index value which co-relates with development of hypotension following sub-arachnoid block for C-section.

Who can participate

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

ASA class II and III
Elective LSCS under sub-arachnoid block
Age 18-35 years

Exclusion criteria

Hypertensive disorders of pregnancy
Autonomic neuropathy
Fetal distress
NPO >8h
Lack of maintenance fluid or oral clear fluid intake during NPO period.
BMI > 35 kg/m2
Patients requiring Vasopressor and Ionotropic support.

Treatment and study plan

Primary outcomes

Incidence of hypotension

Time frame: Intra-operative peroid

Number of episodes of hypotension among both groups will be compared.

Secondary outcomes

Baseline perfusion index as a predictor of hypotension

Time frame: Intra operative peroid

Sensitivity and specificity of baseline perfusion index to predict intra-operative hypotension following sub-arachnoid block

Sponsors and collaborators

Lead sponsor

Muhammad Haroon Anwar

Other Gov

Collaborators

Pakistan Institute of Medical Sciences

Registry information

Important dates

Study start: 2024
Primary completion: 2025
Study completion: 2025
First posted: May 23, 2024
Registry last updated: May 28, 2025

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This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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Completed