Perfusion Index and Pleth Variability Index in Cesarean Section.

Study Overview
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Brief Summary
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The aim of this study is to investigate the predictability of hypotension by using PI and PVI in pre-and post-spinal anesthesia periods in cesarean section cases in the sitting position.

Detailed Description
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Spinal anesthesia has been widely used all over the world due to its superiority to general anesthesia in cesarean section. However, as a result of the sympathetic blockade in spinal anesthesia, vascular tone decreases and hypotension occurs. The incidence of hypotension increases up to 70% in pregnant women due to increased sensitivity to local anesthetics and increased intraabdominal pressure. Improper management of postspinal hypotension may lead to maternal and fetal complications. Predicting the risk of hypotension in patients undergoing spinal anesthesia may allow applications such as volume loading or prophylactic vasopressor use. The perfusion index, measured by pulse Oximeters, correlates with blood flow changes at the tip of the finger so that it can detect hypotension and thus decrease in blood flow after spinal anesthesia. Pleth variability index (PVI) is a non-invasive value found in the new generation pulse oximeters. It is a parameter used in the dynamic measurement of response to fluid therapy in intensive care units. PVI can dynamically give an idea about the fluid status of the pregnant woman. Previous studies have shown that PVI may be a marker for predicting hypotension following spinal anesthesia.

Official Title
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Perfusion Index and Pleth Variability Index in Predicting Hypotension Following Spinal Anesthesia Performed in Sitting Position in Cesarean Section.

Conditions
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Cesarean Section Complications

Intervention / Treatment
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* Device: Masimo Radical-7® Pulse CO-Oximeter®


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Pregnant women who will undergo elective cesarean section Exclusion Criteria: Preeclampsia Cardiovascular disorder Fetal abnormality Patients who failed spinal anesthesia or switched to general anesthesia during operation.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Non-hypotension<br>Patients with a mean arterial pressure reduction of less than 20% and/or systolic arterial pressure above 80 mmHg after spinal anesthesia. | Device: Masimo Radical-7® Pulse CO-Oximeter®<br>* The perfusion index and Pleth variability index will be recorded from the device monitor.<br>|
| Hypotension<br>Patients with a 20% reduction in mean arterial pressure and/or systolic arterial pressure below 80 mmHg after spinal anesthesia. | Device: Masimo Radical-7® Pulse CO-Oximeter®<br>* The perfusion index and Pleth variability index will be recorded from the device monitor.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Perfusion index | Perfusion index will be recorded from the monitor. | Before spinal anesthesia in supine positon | 
| Pleth variability index | Pleth variability index will be recorded from the monitor. | Before spinal anesthesia in supine positon | 
| Perfusion index | Perfusion index will be recorded from the monitor. | Before spinal anesthesia in sitting positon | 
| Pleth variability index | Pleth variability index will be recorded from the monitor. | Before spinal anesthesia in sitting positon | 
| Perfusion index | Perfusion index will be recorded from the monitor. | 1 minutes after spinal anesthesia in supine positon | 
| Pleth variability index | Pleth variability index will be recorded from the monitor. | 1 minutes after spinal anesthesia in supine positon | 
| Perfusion index | Perfusion index will be recorded from the monitor. | Start of the surgery | 
| Pleth variability index | Pleth variability index will be recorded from the monitor. | Start of the surgery | 
| Perfusion index | Perfusion index will be recorded from the monitor. | 1 minutes after the umbilical cord clamping | 
| Pleth variability index | Pleth variability index will be recorded from the monitor. | 1 minutes after the umbilical cord clamping | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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cesarean section, perfusion index, Pleth variability index, sitting position