The role of shock index in prediction of hypotension after spinal anesthesia in elective cesarean section

Objective: The aim of our study is to evaluate the role of shock index in predicting hypotension after spinal anesthesia in elective cesarean section and compare it with other indices (Perfusion Index, Pleth Variability Index, Diastolic Shock Index and Modified Shock Index). Method: Our prospective and observational single center study included 143 pregnant women aged between 18 and 40 years who were scheduled for elective cesarean section by Yozgat Bozok University Medical Faculty Hospital, Department of Obstetrics and Gynecology between 15.07.2021 and 15.07.2022, with American Society of Anesthesiologists score II was done. After the patients came to the preoperative patient preparation unit, their anxiety status was evaluated with the Amsterdam Preoperative Anxiety Score. All data at seven time points; (T0: Supine position before spinal anesthesia, T1: Sitting position during spinal anesthesia, T2: 1.min after spinal anesthesia, T3: 3.min after spinal anesthesia, T4: 5.min after spinal anesthesia, T5: 7.min after spinal anesthesia, T6: 10.min after spinal anesthesia, T7: after umbilical cord clamping) were recorded. Hypotension due to spinal anesthesia was considered as systolic blood pressure below 90 mmHg or ≥ 20% decrease in systolic blood pressure relative to baseline. After spinal anesthesia, the patients were divided into two groups as "Hypotension Developing" and "Hypotension not Developing". Results: Hypotension due to spinal anesthesia developed in 92 (65.7%) of the patients, and it did not develop in 48 (34.3%) patients. APAIS-T and SI-T0 scores were found to be higher in the hypotension group (p=0.036, p=0.013, respectively). Other indices did not differ significantly between the groups (p>0.05). APAIS-T (p=0.008) and SI-T0 (p=0.003) values were found to be independent risk factors for hypotension due to SA in the logistic regression analysis performed for the factors affecting hypotension due to spinal anesthesia. Conclusion: Based on the findings of our study, we believe that preoperative anxiety score and shock index value can be a guide in predicting spinal anesthesia-induced hypotension and in early intervention in pregnant women undergoing elective cesarean section. We think that there is a need for more comprehensive studies on this subject. Key words: Spinal anesthesia, hypotension, shock index, cesarean section, diastolic shock index, modified shock index