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Differential Roles of the Right and Left Toe Perfusion Index in Predicting the Incidence of Postspinal Hypotension During Cesarean Delivery

Xu, Zifeng MD, PhD*; Xu, Tao MD*; Zhao, Puwen MD*; Ma, Rui MD*; Zhang, Mazhong MD, PhD; Zheng, Jijian MD, PhD

doi: 10.1213/ANE.0000000000002393
Obstetric Anesthesiology: Original Clinical Research Report

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.

Published ahead of print August 8, 2017.

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.

Accepted for publication July 11, 2017.

Published ahead of print August 8, 2017.

Funding: This study was sponsored by the Science and Technology Support Program from the Science and Technology Commission of Shanghai Municipality (124119a3400 to Z.X.), the interdisciplinary Program of Shanghai Jiao Tong University (YG2015MS45 to Z.X.), and the National Natural Science Foundation of China (81271263 to J.Z. and 81270414 to M.Z.).

The authors declare no conflicts of interest.

IRB Information: The International Peace Maternity and Child Health Hospital Research Ethics Committee, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Reprints will not be available from the authors.

Address correspondence to Mazhong Zhang, MD, PhD, and Jijian Zheng, MD, PhD, Department of Anesthesiology & Pediatric Clinical Pharmacology Laboratory, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dongfang Rd, Pudong, Shanghai 200127, China. Address e-mail to zmzscmc@shsmu.edu.cn and zhengjijian626@sina.com.

© 2017 International Anesthesia Research Society
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