Perfusion Index as a Predictor of Hypotension Following Spinal Anesthesia in Lower Segment Caesarean Section
DOI:
https://doi.org/10.51985/Keywords:
Hypotension, Lower segment cesarean section, Perfusion index, Spinal AnesthesiaAbstract
Objective: To assess the diagnostic accuracy of preoperative pulse oximetry-derived Perfusion Index (PI) as a non-invasive tool for predicting spinal anesthesia-induced hypotension in parturients undergoing elective lower segment cesarean section (LSCS).
Study Design and Setting: Cross-sectional study, Department of Anesthesia, PAF Hospital Islamabad / Fazaia Medical College, from September 2022 to March 2023.
Methodology: A total of 120 healthy parturients (ASA I–III, aged 16–38 years) listed for elective LSCS under spinal anesthesia were included through consecutive sampling. Participants were grouped into Group A (High PI more than or equal to 3.5, n=60) or Group B (Low PI < 3.5, n=60) based on baseline preoperative PI values. Hemodynamic parameters and hypotensive episodes were observed every 3 minutes for 60 minutes post-block. Data was analyzed using SPSS version 26.0
Results: Group A showed a significantly higher incidence of hypotension compared to Group B [75.0% (n=45) vs. 35.0% (n=21); P < 0.001]. The baseline PI cutoff of 3.5 predicted spinal anesthesia-induced hypotension with a sensitivity of 68.2%, specificity of 72.2%, positive predictive value of 75.0%, negative predictive value of 65.0%, and a diagnostic accuracy of 70.0%. Considerably, 66% (n=43) of all hypotensive events occurred during the critical early window of first 20 minutes.
Conclusion: A baseline preoperative perfusion Index more than or equal to 3.5 is a reliable, non-invasive, cost-effective predictor of early-onset spinal anesthesia-induced hypotension in obstetric patients, allowing a clinical shift from reactive treatment to proactive, individualized hemodynamic management
Downloads
References
1. Heesen M, Klimek M, Hoeks SE, Rossaint R. Prevention of
Spinal Anesthesia-Induced Hypotension During Cesarean
Delivery by 5-Hydroxytryptamine-3 Receptor Antagonists:
A Systematic Review and Meta-analysis and Meta-regression.
Anesth Analg. 2016 Oct;123(4):977-88. doi: 10.1213/ANE.
0000000000001511. PMID: 27537930.
2. Kondo Y, Nakamura E, Noma H, Shimizu S, Goto T, et al.
(2025) Ability of pulse oximetry-derived indices to predict
hypotension after spinal anesthesia for cesarean delivery: A
systematic review and meta-analysis. PLOS ONE 20(1):
e0316715. https://doi.org/10.1371/journal.pone.0316715
3. Campbell TA, Sanson TG. Cardiac arrest and pregnancy. J
Emerg Trauma Shock. 2009 Jan;2(1):34-42. doi: 10.4103/0974-
2700.43586. PMID: 19561954; PMCID: PMC2700584.
4. Babul A, Ashraf S, Free L, Desai J, Hussain M, Rashid T,
Babul N. Prevention of post-spinal hypotension in high risk
cesarean delivery: A systematic review and updated network
meta-analysis of prophylactic vasopressor infusions. Indian
J Anaesth. 2026 Jan;70(1):102-114. doi: 10.4103/ija.ija_
1139_25. Epub 2026 Jan 2. PMID: 41696396; PMCID:
PMC12900202.
5. Ngan Kee WD. The use of vasopressors during spinal
anaesthesia for caesarean section. Curr Opin Anaesthesiol.
2017 Jun;30(3):319-325. doi: 10.1097/ACO.0000000000000
453. PMID: 28277383.
6. Hung KC, Liu CC, Huang YT, Wu JY, Chen JY, Ko CC, Lin
CM, Hsing CH, Yew M, Chen IW. Predictive Efficacy of the
Perfusion Index for Hypotension following Spinal Anesthesia
in Parturient Undergoing Elective Cesarean Section: A
Systematic Review and Meta-Analysis. Diagnostics (Basel).
2023 Aug 3;13(15):2584. doi: 10.3390/diagnostics13152584.
PMID: 37568947; PMCID: PMC10417716.
7. Harde MJ, Ranale PB, Fernandes S. Perfusion index to predict
post spinal hypotension in lower segment caesarean section.
J Anaesthesiol Clin Pharmacol. 2024 Jan-Mar;40(1):37-42.
doi: 10.4103/joacp.joacp_178_22. Epub 2023 Jan 12. PMID:
38666170; PMCID: PMC11042097.
8. Kesavankutty MP, Panda C, Karim HMR, Singha S, Agrawal
S. The diagnostic accuracy of preoperative perfusion index
as a predictor of postspinal anesthesia hypotension in parturients
undergoing cesarean delivery: A prospective non-blinded
observational study. Saudi J Anaesth. 2024 Jan-Mar;18(1):23-
30. doi: 10.4103/sja.sja_378_23. Epub 2024 Jan 2. PMID:
38313707; PMCID: PMC10833017.
9. Inamanamelluri R, Das S, Senapati LK, Pradhan A. Perfusion
Index and Its Correlation With Intraoperative Hypotension
in Lower-Segment Cesarean Section Under Spinal Anesthesia:
A Prospective Observational Study in a Tertiary Care Hospital
in Eastern India. Cureus. 2022 Oct 18;14(10):e30431. doi:
10.7759/cureus.30431.
10. Jabarulla R, Dhivya D, Kumar MSP. To Study the Role of
Perfusion Index as a Predictor of Hypotension during Spinal
Anesthesia in Lower Segment Cesarean Section - A Prospective
Observational Study. Anesth Essays Res. 2021;15(3):263-
267. doi: 10.4103/aer.aer_50_21.
11. Lal J, Bansal T, Bhardwaj S, Jain M, Singh AK. A study to
evaluate perfusion index as a predictor of hypotension
following spinal anesthesia for caesarean section. J Anaesthesiol
Clin Pharmacol. 2022;38(2):294-299. doi: 10.4103/joacp.
JOACP_385_20.
12. M G N, Srinivasaiah M, Prabhat K S J, V C, Kuradagi M,
Mulla R, et al. Peripheral Perfusion Index: A Predictor of
Post-Spinal Hypotension in Caesarean Section. Cureus.
2022;14(6):e25699. doi: 10.7759/cureus.25699.
13. Manap NSA, Zaini RHM, Shukeri WFWM, Omar SC, Abu
Bakar MZ, Seevaunnamtum P. Pulse oximetry-based perfusion
index as a non-invasive indicator of systemic hemodynamics
during spinal anesthesia in cesarean delivery. Anaesth Pain
Intensive Care. 2024;28(5):927-932. doi: 10.35975/apic.
v28i5.2570.
14. Kumar U, Tripathi A, Somvanshi M, Karasala V. Clinical
evaluation of perfusion index (PI) as a predictor of post spinal
hypotension in lower segment caesarean section (LSCS).
Indian J Clin Anaesth. 2022;9(4):445-449. doi: 10.18231/j.ijca.
2022.090.
15. Malavika, Aithal RR, Shwetha G, Surhonne N, Rani DD,
Kannan S. Perfusion index as a predictor of hypotension
following subarachnoid block in parturients with non-severe
pre-eclampsia undergoing lower segment cesarean section.
Int J Health Sci. 2022;6(S3):9512–9520. doi: 10.53730/ijhs.
v6nS3.8371.
16. Yu C, Gu J, Liao Z, Feng S. Prediction of spinal anesthesiainduced hypotension during elective cesarean section: a
systematic review of prospective observational studies. Int J
Obstet Anesth. 2021;47:103175. doi: 10.1016/j.ijoa.2021
.103175.
17. Hussain A, Manzoor H, Manzoor SM, Taj A, Ommid M.
Perfusion index as a predictor of hypotension following
propofol induction- A prospective observational study. Int J
Creat Res Thoughts. 2020 Oct;8(10):911-916.
18. Kuwata S, Suehiro K, Juri T, Tsujimoto S, Mukai A, Tanaka
K, et al. Pleth variability index can predict spinal anaesthesiainduced hypotension in patients undergoing caesarean delivery.
Acta Anaesthesiol Scand. 2018;62(1):75-84. doi: 10.1111
/aas.13012.
19. Chang YJ, Liu CC, Huang YT, Wu JY, Hung KC, Liu PH, et
al. Assessing the Efficacy of Inferior Vena Cava Collapsibility
Index for Predicting Hypotension after Central Neuraxial
Block: A Systematic Review and Meta-Analysis. Diagnostics
(Basel). 2023;13(17):2819. doi: 10.3390/diagnostics13172819.
20. Duggappa DR, Lokesh M, Dixit A, Paul R, Raghavendra Rao
RS, Prabha P. Perfusion index as a predictor of hypotension
following spinal anaesthesia in lower segment caesarean
section. Indian J Anaesth. 2017;61(8):649-654. doi: 10.4103
/ija.IJA_429_16.
21. Frassanito L, Sonnino C, Piersanti A, Zanfini BA, Catarci S,
et al. Performance of the Hypotension Prediction Index With
Noninvasive Arterial Pressure Waveforms in Awake Cesarean
Delivery Patients Under Spinal Anesthesia. Anesth Analg.
2022;134(3):633-643. doi: 10.1213/ANE.0000000000005754.
22. Xu Z, Xu T, Zhao P, Ma R, Zhang M, Zheng J. Differential
Roles of the Right and Left Toe Perfusion Index in Predicting
the Incidence of Postspinal Hypotension During Cesarean
Delivery. Anesth Analg. 2017;125(5):1560-1566. doi:
10.1213/ANE.0000000000002393.
23. Noffsinger SR. Evidence-Based Prevention Strategies for the
Management of Spinal Anesthesia-Induced Hypotension in
Healthy Parturients Undergoing Elective Cesarean Delivery.
AANA J. 2022;90(4):311-316. (PMID: 35943759)
Downloads
Published
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Journal of Bahria University Medical & Dental College is an open access journal and is licensed under CC BY-NC 4.0. which permits unrestricted non commercial use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc/4.0
