Plethysmographic Variability Index in Post Spinal Anesthesia Hypotension in Cesarean Section
Condition: Complication of Anaesthesia During Labour and Delivery
MeSH terms: Hypotension
Study type: Observational [Patient Registry]

Summary: 
      -  Full term pregnant female patients presented for elective C.S for single viable fetus
           will be included in this study.

        -  Before anesthesia, the patient will be attached to a monitor of: ECG , heart rate, non
           invasive blood pressure, pulse taximeter applied on the index finger of the limb not
           attached to the blood pressure cuff, pulse oximetry and plethysmographic variability
           index (PVI) and perfusion index (PI) will be taken by (Massimo radical 7, Massimo corp.
           USA). Measures will be recorded every 5 minutes preoperative.

        -  Patients with PVI <15 will be excluded from the study.

        -  Patients with PVI > 15 are started on intravenous infusion of warm ringer lactate
           solution via suitable pore intravenous cannula to reach target of PVI <15 or a total 1
           liter of ringer lactate.

        -  The patients in which the PVI is corrected by fluid to level below 15 will be Group (C)
           or corrected group. Patients in which intravenous fluid administration did not result
           any change in PVI or changed but still higher than 15 will be Group (NC) or non
           corrected group.

      After preoperative preparation patient is shifted to operating theater, with all monitors
      applied. She will receive spinal block at lumbar 3-4 space with hyperbaric bupivacaine 8 mg
      plus 25 mic fentanyl. After giving anesthesia and positioning for surgery with a left lateral
      tilt of 15 degrees,
    

Detailed description: 
      -  This prospective observational study will be carried out on all pregnant women who will
           undergo elective cesarean section in obstetric department in Tanta university hospitals
           under spinal anesthesia over four month duration that starts immediately after obtaining
           ethical committee approval, an informed written consent will be included with the
           consent for spinal anesthesia for cesarean section, all patients data will be
           confidential and will be used for the current study only.

        -  Inclusion criteria:

      Pregnant women which are listed to undergo elective caeserian section for single viable baby
      under spinal anesthesia.

        -  Exclusion criteria:

             -  Patients with pregnancy less than 36 weeks or more than 40 weeks

             -  Patients with hypertension , pre-eclampsia , eclampsia.

             -  Patients with diabetes

             -  Patients with cardiovascular disease and /or arrhythmia.

             -  Patients with placenta previa, accreta, percreta.

             -  Obese patients with BMI >36

             -  Polyhydramnious patients

        -  On arrival of patients to pre-anaesthesia preparation room, we will allow patients to
           rest in supine position with 15 degree left tilt by pillow wedge under right hip, after
           allowing patient to rest for five minutes, measures are recorded: ECG , heart rate, non
           invasive blood pressure, pulse oximeter applied on the index finger of the limb not
           attached to the blood pressure cuff, pulse oximetry and Plethysmography variability
           index (PVI) and perfusion index (PI) will be taken by (Massimo radical 7, Massimo corp.
           USA). Measures will be recorded every 5 minutes preoperative. Patients with PVI <15 are
           excluded from the study.

      Patients with PVI > 15 are started on intravenous infusion of warm ringer lactate solution
      via suitable pore intravenous cannula to reach target of PVI <15 or a total 1 liter of ringer
      lactate.

      The patients in which the PVI is corrected by fluid to level below 15 will be Group (C) or
      corrected group. Patients in which intravenous fluid administration did not result any change
      in PVI or changed but still higher than 15 will be Group (NC) or non corrected group.

      After preoperative preparation patient is shifted to operating theater, with all monitors
      applied. She will receive spinal block at lumbar 3-4 space with hyperbaric bupivacaine 8 mg
      plus 25 mic fentanyl. After giving anesthesia and positioning for surgery with a left lateral
      tilt of 15 degrees, supplemental oxygen at rate of 4 liter/minute is applied.

      Measurements will be taken every minute till delivery of the baby, and if the blood pressure
      is decreased below 20% of the baseline level before anesthesia, patients will be given
      incremental doses of ephedrine sulfate 0.1 mg /kg till blood pressure normalized above 80% of
      pre-anesthesia level. All measurements will be recorded in tables and subjected to
      statistical analysis.
    

Intervention name(s): Spinal Anesthesia
Intervention type(s): Procedure
Intervention description(s): The patients will receive spinal block at lumbar 3-4 space with hyperbaric bupivacaine 8 mg plus 25 mic fentanyl. After giving anesthesia and positioning for surgery with a left lateral tilt of 15 degrees, supplemental oxygen at rate of 4 liter/minute is applied.
Intervention MeSH terms: Anesthetics
Observational model: Other
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Full term pregnant female patients presented for elective cesarean section delivery of a
        single viable fetus under spinal anesthesia/