The prediction of hemodynamic unstability by increasing values of perfusion index and pleth variable index after spinal block in elective cesarean secti̇on

OBJECTIVE: Today, spinal anesthesia (SA); Since it is less risky for maternal and new born health compared to general anesthesia, it is a more preferred method in elective cesareansection operations. Hypotension due to spinal anesthesia, which is the most common side effect of spinal anesthesia, is frequently seen in patients. Due to the negative consequences of hypotension on the mother and newborn; It is important to take the necessary precautions against this hemodynamic deterioration. Perfusion index (PI) and pleth variability index (PVI) are parameters that can be measured noninvasively by pulseoximetry. In our study; By examining the lower extremity PI and PVI values in patients who will undergo elective cesareansection with SA; We investigated the usability and superiority of these values over each other in predicting hemodynamic deterioration. METHODS: This research; It was conducted as a prospective observational study and 113 pregnant women aged 18-40 years who were ASA1-2 who were going to undergo lower segment cesarean section were included in our study. Demographic data of the patients (age, gender, weight, height, BMI) and routine hemogram values (hemoglobin, hematocrit, platelet, wbc) taken for preoperative evaluation were recorded. After the patients were placed on the operating table, PI and PVI values in the supine and sitting positions, PI and PVI values at the 1st, 2nd, 3rd, and 4th minutes after spinal anesthesia was applied to the patient, and finally, the postpartum PI, PVI values were recorded. In addition, in order to follow up the hemodynamic changes in all patients in thes tudy, Standard monitoring including electrocardiography, non-invasive blood pressure measurements and pulse measurement was performed, and changes in systolic pressure, diastolic pressure and heart rate were recorded before and after spinal anesthesia. v RESULTS: There was no difference in BMI and weight values between patients who developed and did not develop hypotension after spinal anesthesia. In basal values of PI and PVI and the rate of change of these values; There was no significant difference between the groups with and without hypotension. Hemoglobin (p=0.014) and hematocrit (p=0.012) values weres ignificantly lower in pregnant women who developed hypotension. The 1st minute APGAR (p=0.005= and 5th minute APGAR (p=0.014) scores were significantly lower in the babies of pregnant women who developed hypotension. There was no statistically significant change in PI and PVI values in patients who failed spinal anesthesia application. CONCLUSION: As a result, in our study; It has been determined that monitoring PI and PVI values will not provide the expected benefit in predicting the hemodynamic in stability that may occur in patients under going cesarean section under spinal anesthesia, and these values do not have diagnostic superiority over each other. However, it was concluded that following the lower extremity PI values after spinal anesthesia can enlighten us about the success of spinal block. In addition, it has been determined that low hemogram and hematocritvalues increase the risk of developing hypotension. KEYWORDS: Hypotension, Perfusion index, Pleth Variability Index, Spinal Anesthesia