Feyza ÇALIŞIR, Adem DOĞANER, Cengizhan YAVUZ, Mehmet KANDİLCİK, Bora BİLAL, Mahmut ARSLAN, Gözen ÖKSÜZ

Sezaryen Operasyonlarında Spinal Anesteziye Bağlı Hipotansiyon Perfüzyon İndeksi veya Pleth Variabilite İndeks ile Öngörülebilir mi?

Amaç: Sezaryen operasyonlarında tercih edilen anestezi yöntemi spinal anestezidir, ancak hasta- ların önemli bir kısmında hipotansiyona yol açar. Bu çalışmada, farklı pozisyonlardaki perfüzyon indeksi (Pİ) ve pleth variabilite indeksi (PVİ) değerlerinin sezaryen operasyonu için uygulanan spinal anestezi sonrası gelişen hipotansiyonu öngörme kabiliyetini değerlendirdik. Yöntem: Spinal anestezi ile alt segment sezaryen operasyonu olacak 90 gebe çalışmaya dahil edildi. Preoperatif hazırlık odasında supin, yarı oturur, pasif bacak kaldırma ve sol lateral dekübit pozisyonlarda iken, Pİ ve PVİ değerleri kaydedildi. Sonra hastalar ameliyat odasına alındı ve supin ve oturur pozisyonlarda Pİ ve PVİ değerleri yeniden kaydedildi. Oturur pozisyonda L3-L4 veya L4-L5 aralıklarından 10 mg %0.5 bupivakain ile spinal anestezi uygulandı. Spinal anesteziden bir dk sonraki Pİ ve PVİ değerleri postspinal değerleri olarak kaydedildi. Bağımsız değişkenlerin hipo- tansiyon üzerine etkileri logistik regresyon analizi ile değerlendirildi. Pİ ve PVİ değerleri ile hipo- tansiyon arasındaki ilişki ROC analizi ile değerlendirildi. Bulgular: Hipotansiyon insidansı %60 idi. Spinal sonrası hipotansiyon için post-spinal PVİ değeri- nin zayıf prediktif değeri olduğunu saptadık (AUC=0.663, 95% CI 0.530-0.796, p=0.024). Sonuç: Değerlendirilen parametreler arasında, sezaryen operasyonlarında spinal anesteziye bağlı gelişen hipotansiyonla yalnızca post-spinal PVİ arasında ilişki saptandı. Ancak, bu değerin düşük spesifisite ve sensitivitesi nedeniyle rutin klinik uygulamada yararlı olmayabilir.

Can Perfusion Index or Pleth Variability Index Predict Spinal Anesthesia-Induced Hypotension During Caesarean Section?

Objective: Although spinal anesthesia is the preferred anesthetic method for cesarean sections,it leads to hypotension in a significant proportion of the patients. In this study, we assessed thepredictive ability of perfusion index (PI) and Pleth variability index (PVI) in different positions, forprediction of hypotension after spinal anesthesia administered for cesarean delivery.Methods: Ninety parturients scheduled for elective lower segment cesarean section under spinalanesthesia were enrolled in the study. In the preoperative holding area, PI and PVI values wererecorded in the supine, semi-recumbent, passive leg raise and left lateral positions. Then, partu-rients were taken to the operating room; their PI and PVI values were recorded again in thesupine and sitting positions. Spinal anesthesia was performed with 0.5% hyperbaric bupivacaine(10 mg) injected through L3-L4 or L4-L5 interspaces with the patient in the sitting position. PI andPVI values were recorded one minute after induction of spinal anesthesia as postspinal measure-ments. The effects of independent variables on hypotension were examined with logistic regres-sion analysis. The relationship between PI and PVI values and incidence of hypotension wasevaluated using ROC analysis.Results: The incidence of hypotension was 60 percent. Postspinal PVI was found to have a weakpredictive value for postspinal hypotension (AUC=0.663, 95% CI 0.530-0.796, p=0.024).Conclusion: Among the parameters evaluated, only postspinal PVI was associated with spinalanesthesia-induced hypotension in cesarean section. However, it may not be useful in routineclinical practice due to its low specificity and sensitivity.

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