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Background and Aims: Low back pain is a common problem and a major burden to society. Transforaminal epidural steroid injection is one of the most effective treatment modalities for back pain. We aim to objectively quantify pain relief of lumbosacral radicular pain post transforaminal steroid injection by correlating perfusion index (PI), reflecting real‑time peripheral blood flow change at the site of monitoring, controlled by sympathetic system with Numerical rate score (NRS) and SLRT improvement. Material and Methods: A prospective observational study, conducted at K.S Hegde Medical Academy, Mangaluru, from June 2021 to June 2022 as a time‑bound study. After IEC clearance (IEC certificate number) for the procedure and study, patients undergoing transforaminal epidural steroid injection for lumbosacral radicular pain were enrolled, excluding those meeting the exclusion criteria. PI change and NRS score improvement were noted at 0, 5, 10, 15, and 30 minutes along with pre and post‑procedure SLRT. Results were analyzed. Results: A total of 40 patients were analyzed. PI change at 30 minutes was 2.113 from a baseline of 0.217. Median NRS of 5, improved to 0 and the mean SLRT of 45.17 to 61.45 at the end of 30 minutes. All changes are statistically significant with P (<0.01). correlation between the PI change with NRS is mild (‑0.312). Conclusion: PI change ratio shows an overall improvement in pain levels objectively, in a non‑invasive, easy, and reliable way. Simultaneous improvement in both NRS and SLRT is clinically significant but cannot predict a correlated quantitative measure of pain relief. [ABSTRACT FROM AUTHOR]

Perfusion index (PI) and CRIB (Clinical risk index of babies) Score II both are minimally invasive tools for prediction of mortality and morbidity in sick neonates. This study aims to know the predictive values of both PI and CRIB Score II in assessment of severity of illness in preterm neonates of 28 to 32 weeks and their correlation.PI and CRIB II Score of 125 sick preterm neonates admitted in NICU were assessed within 12 hours of admission. Severity noted in form of outcome. Correlation between PI and CRIB Score II were observed.Receiver operating characteristic (ROC) curve were plotted for PI and CIRB Score II with outcome (discharged vs expired). Area under curve for perfusion index was 0.776 at 95% confidence interval. Optimum cutoff point based on ROC curve was 1.65 with sensitivity of 84%., specificity of 37.2% with positive predictive value of 70% and negative predictive value of 57%. Area under curve for CRIB Score II was 0.622 (p value < 0.028), optimum cut off point based on ROC curve for CRIB II score was 3.5 with sensitivity 79.10% of specificity of 40% positive predictive value is 43.03% and negative predictive value of 76.9%. Spearman’s correlation coefficient between PI and CRIB II score was –0.272 and p value is 0.002.This study concluded that perfusion index (p < 0.001) is better for predicting the severity compared to CRIB II score (p < 0.028). A weak negative correlation exists between PI and CRIB II score (r = –0.272). [ABSTRACT FROM AUTHOR]

Perfusion index (PI) is used as assessment of epidural anaesthesia efficacy in human medicine, but its usefulness in dogs is unknown. The aim of this study was to evaluate the usefulness of PI in determining epidural anaesthesia effectiveness. This is prospective cross-over experimental study. Five healthy adult beagle dogs were anaesthetised and an epidural catheter was inserted in the lumbosacral area and adjusted so that the end of the catheter was placed at the fourth lumbar vertebra. Single-port catheters were used in the control group and multiple-port catheters were used in the treatment group. A PI probe was placed on a hind leg, and the catheter placement was confirmed via computed tomography. The treatment group received a bolus dose of lidocaine, and the control group received saline, via epidural catheter. The PI value was recorded every 5 min until 30 min after lidocaine injection. The PIs of the hind limbs were not significantly different over time, nor were they between the control and lidocaine-injected groups at any point in time. The PI is not useful in determining the efficacy of epidural anaesthesia in dogs under general anaesthesia. In the future, finding a reliable method to evaluate the success of regional anaesthesia, even in patients under general anaesthesia, will be necessary. [ABSTRACT FROM AUTHOR]

Post-induction hypotension (PIH) is a common and potentially serious complication of general anesthesia. This meta-analysis (Prospero registration number: CRD42024566321) aimed to evaluate the predictive efficacy of the perfusion index (PI) for PIH in patients undergoing general anesthesia. A comprehensive literature search was performed using multiple electronic databases (Google Scholar, EMBASE, Cochrane Library, and MEDLINE). Studies involving adult patients undergoing general anesthesia, with the PI measured before anesthesia induction and reporting PIH incidence, were included. The primary outcome was the diagnostic accuracy of the PI in predicting the probability of PIH. The secondary outcome was the pooled PIH incidence. Eight studies with 678 patients were included. The pooled incidence of PIH was 44.8% (95% confidence interval [CI]: 29.9%–60.8%). The combined sensitivity and specificity of the PI for predicting PIH were 0.84 (95% CI: 0.65–0.94) and 0.82 (95% CI: 0.70–0.90), respectively. The summary receiver operating characteristic (sROC) analysis revealed an area under curve of 0.89 (95% CI: 0.86–0.92). The Deek's funnel plot asymmetry test indicated no significant publication bias. The PI demonstrates high predictive efficacy for PIH in patients undergoing general anesthesia, indicating that it can be a valuable tool for identifying those at risk of PIH. [ABSTRACT FROM AUTHOR]

One of the regional anesthetic procedures, caudal epidural block, is important for lower extremities surgeries in the pediatric patient population. The perfusion index (PI) value, which reflects vasomotor tone, can be used to indicate block success. The aim was to compare the role of perfusion index, heart rate, and mean arterial pressure in detecting the success of caudal epidural block and to investigate whether perfusion index was an earlier indicator in determining the success of the block in pediatric surgery cases. A randomized controlled trial. The study included 58 patients, American Society of Anesthesiologists'classification 1, between the ages 1 and 6 years. In the left lateral decubitus posture, caudal epidural block was performed using a 23 or 25-gauge caudal needle and a dosage of 0.25% bupivacaine (1 mL/kg). At the 0, 1, 5, 7, 10, 15, and 20th minutes, peripheral oxygen saturation, heart rate, mean arterial pressure, and PI values were obtained using a probe attached to the first toe of the left foot. A successful caudal epidural block indication was defined as an increase of at least 100% in the PI value over the baseline value and a 15% decrease in mean arterial pressure and heart rate PI represents the ratio of the photoplethysmography signal to pulsatile over nonpulsatile light absorbance. An increase in the PI value indicates that the block is effective. In the 20-minute follow-up period after caudal epidural block, there was at least a 100% increase in PI value in all of the patients at the seventh minute. An expected 15% reduction in mean arterial pressure was observed in 14.5% of the patients and an expected 15% reduction in heart rate was observed in 45.6% of the patients. The results obtained from our study show that the increase in PI values is associated with caudal epidural block success. The PI value is more rapid, sensitive and objective than those produced by other parameters. Benefits include an earlier change in anesthesia management due to block failure and faster initiation to surgery, which reduces exposure to anesthetic chemicals. [ABSTRACT FROM AUTHOR]

Aim: Hookah smoking is increasing all over the world, and it can cause many health problems that are rarely known to be experienced by smokers. The aim of this study was to evaluate the acute impact of hookah smoking on hemodynamic parameters using perfusion index (PI) and pleth variability index (PVI). Materials and Methods: This prospective observational study was conducted in a hookah cafe with 84 participants. Systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse, oxygen saturation (SpO2), carboxyhemoglobin (COHb) PI, and PVI values of the participants were measured immediately before and 30 min after hookah smoking. Results: Sixty-three (75%) participants were male, and the median age was 26 [interquartile range (IQR) 22-29]. There were no significant changes in SBP, DBP, pulse, and SpO2 following hookah smoking. There was a 2% (IQR 2-3) increase in COHb level (p

Background: To reduce the dosages of the intraoperative anaesthetic and analgesic agents, the caudal block is most frequently used in children. The work aims to investigate the efficacy of perfusion index (PI) and heart rate (HR) variations following the caudal block in determining the onset and appropriateness of the caudal block in children. Patients and methods: After induction of general anaesthesia, 0.5–1 ml/kg of 0.25% bupivacaine according to the needed block level using a 22-gauge needle. Bupivacaine dose was given as an initial injection of 0.2 ml/kg for 3–4 s; the remaining dose was given at the same flow after 1 min. The lowest HRs were observed during and up to 1 min after the initial injection, as well as during and up to 1 min after the complete drug delivery. Prior to and every 2 min following the caudal block, the PI of all children was measured. Results: There was a significant difference between the caudal success group and the caudal failure group regarding median PI (p < 0.001). At the initial and total caudal bupivacaine doses, there was a significant fall between the median HR caudal success group and the median HR caudal failure group (p < 0.001). Conclusion: A decrease in HR of −2 and −3 beats/minute during or shortly after an initial and entire caudal drug injection, respectively, and median PI are reliable methods in the prediction of caudal success. [ABSTRACT FROM AUTHOR]

Background: Intraoperative fluid therapy maintains normovolemia, normal tissue perfusion, normal metabolic function, normal electrolytes, and acid–base status. Plethysmographic variability index has been shown to predict fluid responsiveness but its role in guiding intraoperative fluid therapy is still elusive. Aims: The aim of the present study was to compare intraoperative goal‐directed fluid therapy based on plethysmographic variability index with liberal fluid therapy in term neonates undergoing abdominal surgeries. Methods: A prospective randomized controlled study was conducted in a tertiary care centre, over a period of 18 months. A total of 30 neonates completed the study out of 132 neonates screened. Neonates with tracheoesophageal fistula, congenital diaphragmatic hernia, congenital heart disease, respiratory disorders, creatinine clearance <90 mL/min and who were hemodynamically unstable were excluded. Neonates were randomized to goal‐directed fluid therapy group where the plethysmographic variability index was targeted at <18 or liberal fluid therapy group. Primary outcome was comparison of total amount of fluid infused intraoperatively in both the groups. Secondary outcomes included intraoperative and postoperative arterial blood gas parameters, biochemical parameters, use of vasopressors, number of fluid boluses, complications and duration of hospital stay. Results: There was no significant difference in total intraoperative fluid infused [90 (84–117.5 mL) in goal‐directed fluid therapy and 105 (85.5–144.5 mL) in liberal fluid therapy group (p =.406)], median difference (95% CI) −15 (−49.1 to 19.1). There was a decrease in serum lactate levels in both groups from preoperative to postoperative 24 h. The amount of fluid infused before dopamine administration was significantly higher in liberal fluid therapy group (58 [50.25–65 mL]) compared to goal‐directed fluid therapy group (36 [22–44 mL], p =.008), median difference (95% CI) −22 (−46 to 2). In postoperative period, the total amount of fluid intake over 24 h was comparable in two groups (222 [204–253 mL] in goal‐directed fluid therapy group and 224 [179.5–289.5 mL] in liberal fluid therapy group, p =.917) median difference (95% CI) cutoff −2 (−65.3 to 61.2). Conclusion: Intraoperative plethysmographic variability index‐guided goal‐directed fluid therapy was comparable to liberal fluid therapy in terms of total volume of fluid infused in neonates during perioperative period. More randomized controlled trials with higher sample size are required. Trial Registration: Central Trial Registry of India (CTRI/2020/02/023561). [ABSTRACT FROM AUTHOR]

OBJECTIVES The multifactorial dynamic perfusion index was recently introduced as a predictor of cardiac surgery-associated acute kidney injury. The multifactorial dynamic perfusion index was developed based on retrospective data retrieved from the patient files. The present study aims to prospectively validate this index in an external series of patients, through an on-line measure of its various components. METHODS Inclusion criteria were adult patients undergoing cardiac surgery with cardiopulmonary bypass. Data collection included preoperative factors and cardiopulmonary bypass-related factors. These were collected on-line using a dedicated monitor. Factors composing the multifactorial dynamic perfusion index are the nadir haematocrit, the nadir oxygen delivery, the time of exposure to a low oxygen delivery, the nadir mean arterial pressure, cardiopulmonary bypass duration, the use of red blood cell transfusions and the peak arterial lactates. RESULTS Two hundred adult patients were investigated. The multifactorial dynamic perfusion index had a good (c-statistics 0.81) discrimination for cardiac surgery-associated acute kidney injury (any stage) and an excellent (c-statistics 0.93) discrimination for severe patterns (stage 2–3). Calibration was modest for cardiac surgery-associated acute kidney injury (any stage) and good for stage 2–3. The use of vasoconstrictors was an additional factor associated with cardiac surgery-associated acute kidney injury. CONCLUSIONS The multifactorial dynamic perfusion index is validated for discrimination of cardiac surgery-associated acute kidney injury risk. It incorporates modifiable risk factors, and may help in reducing the occurrence of cardiac surgery-associated acute kidney injury. [ABSTRACT FROM AUTHOR]

Several noninvasive solutions are available for the assessment of patients at risk of deterioration. Capnography, in the form of end-tidal exhaled CO2 (ETCO2) and perfusion index (PI), could provide relevant information about patient prognosis. The aim of the present project was to determine the association of ETCO2 and PI with mortality of patients admitted to the emergency department (ED). Multicenter, prospective, cohort study of adult patients with acute disease who needed continuous monitoring in the ED. The study included two tertiary hospitals in Spain between October 2022 and June 2023. The primary outcome of the study was in-hospital mortality (all-cause). Demographics, vital signs, ETCO2 and PI were collected. A total of 687 patients were included in the study. The in-hospital mortality rate was 6.8%. The median age was 79 years (IQR: 69–86), and 63.3% were males. The median ETCO2 value was 30 mmHg (26–35) in survivors and 23 mmHg (16–30) in nonsurvivors (p = 0.001). For the PI, the medians were 4.7% (2.8–8.1) for survivors and 2.5% (0.98–4-4) for nonsurvivors (p < 0.001). The model that presented the best AUC was age (odds ratio (OR): 1.02 (1.00–1.05)), the respiratory rate (OR: 1.06 (1.02–1.11)), and the PI (OR: 0.83 (0.75–0.91)), with a result of 0.840 (95% CI: 0.795–0.886); the model with the respiratory rate (OR: 1.05 (1.01–1.10)), the PI (OR: 0.84 (0.76–0.93)), and the ETCO2 (no statistically significant OR), with an AUC of 0.838 (95% CI: 0.787–0.889). The present study showed that the PI and respiratory rate are independently associated with in-hospital mortality. Both the PI and ETCO2 are predictive parameters with improved prognostic performance compared with that of standard vital signs. [ABSTRACT FROM AUTHOR]

Background: We investigated the performance of the Perfusion Index (PI) derived from pulse oximetry waveform as a tool for assessment of anesthetic depth in comparison with A-line Autoregression Index (AAI) derived from analysis of Middle-Latency Auditory Evoked Potentials (MLAEP) waveform integrated by aepEXplus monitor in children receiving sevoflurane anesthesia for tonsillectomy. Methods: Forty-one patients (4...12 years old) were included in this study. The PI and AAI were recorded simultaneously every minute during different stages of anesthesia delivery. The statistical tests included descriptive analysis, significance tests, correlation tests, and Receiver Operating Characteristic (ROC) curve. The AAI served as a reference. Results: The PI significantly decreased during light anesthesia and recovery, and significantly increased during deeper planes of anesthesia, with an inverse mirror-image relationship with the AAI. A negative correlation of low to moderate degree was detected between PI and AAI during the study (p.ß>.ß0.05), that reached a statistical significance at the 5th minute during sevoflurane mask induction (r.ß=.ß...0.457, p.ß=.ß0.008). ROC analysis at an AAI < 25 extracted the best cut-off value for PI before intubation as 1.48 (AUC.ß=.ß0.698 [0.537...0.859], 94.4% sensitivity, 44.5% specificity) and at 10-minute intraoperatively as 2.4 (AUC.ß=.ß0.537 [0.354...0.721], 91.7% sensitivity, 31% specificity). During recovery, at an AAI.ß....ß50, the best cutoff was 1.82 (AUC.ß=.ß0.661 [0.46...0.863], 100% sensitivity and 50% specificity) 2 minutes before spontaneous eye opening. Conclusions: Compared with the AAI, the PI can track changes in depth of anesthesia in pediatric patients undergoing tonsillectomy under sevoflurane anesthesia. Trial registration: Clinical Trials. Gov. Identifier: NCT03412214.

Background: Perfusion index (PI) is a simple, objective, and noninvasive method for evaluating the success of brachial plexus blocks. There is only one study which assessed the time point at which the PI had the best predictive value. Aims: Of the 5 measured outcome variables (i.e.; PI at baseline, at 5 min, at 10 min, and at 15 min and PI ratio), we wanted to determine the one which had the best predictive value for block success. Materials and Methods: It is a prospective observational study done in a tertiary care teaching hospital. Sixty-nine patients of either sex, American Society of Anesthesiologists Physical Status I and II, between the ages of 18 and 65 years posted for elective upper limb surgery were included. Patients were given supraclavicular blocks with a peripheral nerve stimulator. PI recorded at baseline, 5 min, 10 min, and 15 min. A PI ratio was calculated. Sensory and motor blocks were assessed at 5-min intervals. Statistical Analysis: Descriptive analysis was applied by mean and standard deviation for quantitative variables and frequency and proportion for categorical variables. Receiver operating characteristic (ROC) curves were constructed. SPSS version 22 was used to detect an area under the ROCs (AUROC) curve and calculated to assess how good a test PI at 10 and 15 min and PI ratio are in predicting the outcome of a block. Results: The mean PI increased continuously from the baseline till 15 min in successful blocks, but in unsuccessful blocks, the rise was not seen. ROC curves showed an AUROC curve of 0.93 in case of PI at 15 min and 0.84 for PI ratio. Conclusion: We conclude that PI at 15 min is the best in our study and PI ratio is the next best as a predictor for evaluating success of supraclavicular blocks.

Abstract Background Conventionally, diuretic isotope renogram is used to establish and quantify severity of the obstruction in pelvi-ureteric junction obstruction. Doppler ultrasonography too assesses obstruction by evaluating the resistive index (RI) and resistive index ratio (RIR) in the intrarenal vasculature of the kidneys. This study aimed to note correlation between RI, RIR on Doppler ultrasonography and perfusion index (PI) on diuretic isotope renogram in suspect unilateral pelvi-ureteric junction obstruction in infants. A prospective study (2016–2019) in infants with suspect unilateral hydronephrosis, i.e. anteroposterior pelvic diameter (APPD) > 15 mm, divided into Group A (0–6 months) and Group B (6–12 months) based on the age at diagnosis. The RI, RIR and PI were noted at diagnosis, at 3 and 6 months, post-interventions and the correlation assessed. Results 37/94 with hydronephrosis were included in the study. 30 among these underwent surgical intervention. A decrease in RI and RIR and increase in PI following surgery were documented at follow-up. Also, the improvement was statistically more significant in the first 3 months following intervention. Conclusions An increased RI and RIR and a decreased PI are good indicators of obstruction in unilateral hydronephrosis in infants. The decline in RI with increase in PI following relief of obstruction shows a positive correlation between the two. Doppler sonography may be effective in monitoring unilateral hydronephrosis with unobstructed or equivocal renogram curves and consequently negate the need for repeated nuclear scans.

Objective: To determine the sensitivity and specificity of perfusion index in the right toe and index finger as a predictor of post-spinal hypotension in parturient undergoing Lower Segment caesarean Section (LSCS). Methods: 75 Parturient aged 18 to 35 years who were undergoing LSCS elective procedures, of ASA-II were included in the study. Intraoperative assessment of vital parameters including heart rate, NIBP, Respiratory rate, Sp02 and perfusion index at both finger and toe were recorded every 2 minutes till the 15th minute and then every 5 minutes till the end of the surgery. The data for the study was calculated using the SPSS 20.0 package program. Results: In this study, the mean age was 25.91 years (±3.82), heart rate 95.55 bpm (±14.9), Finger PI 5.64 (±3.49), Toe PI 3.38 (±3.36), and MAP 98.28 mmHg (±8.70). Using ROC analysis, baseline cutoffs for predicting hypotension were identified, Finger PI 3.55 (83.3% sensitivity, 51.1% specificity) and Toe PI 1.85 (80% sensitivity, 56% specificity). Conclusion: The Perfusion Index (PI) can be used as an effective tool for predicting hypotension in healthy parturients posted for elective caesarean section under subarachnoid block. Continuous monitoring of toe PIs during induction of spinal anaesthesia might help to predict the development of post-spinal hypotension and reflect the aorto-caval compression by the gravid uterus. [ABSTRACT FROM AUTHOR]

Objective: Determine correlation between perfusion index in index finger and right toe regarding hypotension during spinal anesthesia in parturients undergoing LSCS. Methods: A cohort of 75 parturients (aged 18 to 35 years), scheduled for elective LSCS and classified as ASA-II, underwent intraoperative vital sign monitoring including heart rate, NIBP, respiratory rate, SpO2, and perfusion index measurements from both finger and toe sites. Readings were taken at twominute intervals until the 15th minute, followed by five-minute intervals until surgery completion. Data were analyzed using SPSS 20.0. Results: Mean age was 25.91 years (±3.82), heart rate 95.55 bpm (±14.9), Finger PI 5.64 (±3.49), Toe PI 3.38 (±3.36), and MAP 98.28 mmHg (±8.70). ROC analysis identified baseline cutoffs for predicting hypotension: Finger PI 3.55 and Toe PI 1.85. Spearman's rank correlation analysis revealed significant correlations between baseline finger perfusion index (>3.5) and hypotension episodes (rs = 0.400, P < 0.000), and baseline toe perfusion index (>1.85) and hypotension episodes (rs = 0.549, P < 0.000), suggesting moderate agreement. Conclusion: Perfusion Index (PI) is a valuable predictor of hypotension in healthy parturients undergoing elective LSCS under subarachnoid block. Continuous toe PI monitoring during spinal anesthesia induction may aid in predicting post-spinal hypotension and assessing aortocaval compression by the gravid uterus. [ABSTRACT FROM AUTHOR]

Background and Aims: Short-term hypotension after general anaesthesia can negatively impact surgical outcomes. This study compared the predictive potential of the pleth variability index (PVI), pulse pressure variability (PPV), and perfusion index (PI) for anaesthesia-induced hypotension. This study's primary objective was to evaluate the predictive potential of PI, PVI, and PPV for hypotension. Methods: This observational study included 140 adult patients undergoing major abdominal surgery under general anaesthesia. Mean arterial pressure, heart rate, PVI, PPV, and PI were collected at 1-min intervals up to 20 min post anaesthesia induction. Hypotension was assessed at 5-min and 15-min intervals. Receiver operating characteristic (ROC) curves were plotted to determine the diagnostic performance and best cut-off for continuous variables in predicting a dichotomous outcome. Statistical significance was kept at P < 0.05. Results: Hypotension prevalence within 5 and 15 min of anaesthesia induction was 36.4% and 45%, respectively. A PI cut-off of <3.5 had an area under the ROC curve (AUROC) of 0.647 (P = 0.004) for a 5-min hypotension prediction. The PVI's AUROC was 0.717 (P = 0.001) at cut-off >11.5, while PPV's AUROC was 0.742 (P = 0.001) at cut-off >12.5. At 15 min, PVI's AUROC was 0.615 (95% confidence interval 0.521-0.708, P = 0.020), with 54.9% positive predictive value and 65.2% negative predictive value. Conclusion: PVI, PPV, and PI predicted hypotension within 5 min after general anaesthesia induction. PVI had comparatively higher accuracy, sensitivity, specificity, and positive predictive value than PI and PPV when predicting hypotension at 15 min. [ABSTRACT FROM AUTHOR]

Background: Conventionally, diuretic isotope renogram is used to establish and quantify severity of the obstruction in pelvi-ureteric junction obstruction. Doppler ultrasonography too assesses obstruction by evaluating the resistive index (RI) and resistive index ratio (RIR) in the intrarenal vasculature of the kidneys. This study aimed to note correlation between RI, RIR on Doppler ultrasonography and perfusion index (PI) on diuretic isotope renogram in suspect unilateral pelvi-ureteric junction obstruction in infants. A prospective study (2016–2019) in infants with suspect unilateral hydronephrosis, i.e. anteroposterior pelvic diameter (APPD) > 15 mm, divided into Group A (0–6 months) and Group B (6–12 months) based on the age at diagnosis. The RI, RIR and PI were noted at diagnosis, at 3 and 6 months, post-interventions and the correlation assessed. Results: 37/94 with hydronephrosis were included in the study. 30 among these underwent surgical intervention. A decrease in RI and RIR and increase in PI following surgery were documented at follow-up. Also, the improvement was statistically more significant in the first 3 months following intervention. Conclusions: An increased RI and RIR and a decreased PI are good indicators of obstruction in unilateral hydronephrosis in infants. The decline in RI with increase in PI following relief of obstruction shows a positive correlation between the two. Doppler sonography may be effective in monitoring unilateral hydronephrosis with unobstructed or equivocal renogram curves and consequently negate the need for repeated nuclear scans. [ABSTRACT FROM AUTHOR]

The study aimed to assess the pleth variability index (PVI) in patients undergoing lumbar disc herniation surgery under general and spinal anesthesia, exploring its correlation with fluid responsiveness, position, and hemodynamic parameters. Methods: This prospective study included 88 ASA 1–2 patients, aged 18–65, undergoing 1–3 h elective lumbar disc herniation surgery. Patients in groups GA and SA were observed for demographic, operative, and hemodynamic parameters at specified time points. (3) Results: PVI values were comparable between the GA and SA groups. After 250 mL of fluid loading, both groups showed a significant decrease in basal PVI at T2. Prone positions in GA exhibited higher PI values than in SA. The transition from a prone to supine position maintained PVI, while pulse and MAP decreased.; (4) Conclusions: PVI values were comparable in elective lumbar disc herniation surgery with general and spinal anesthesia. Both groups exhibited significant a PVI decrease at T2 after 250 mL of fluid loading, indicating fluid responsiveness. In general anesthesia, the prone position showed a lower MAP and higher PI values compared to spinal anesthesia. PVI and PI, sensitive to general anesthesia changes, could have beneficial additions to standard hemodynamic monitoring in spinal anesthesia management. [ABSTRACT FROM AUTHOR]

Objective: To compare the differences in noninvasive perfusion index (PI) before and after extubation between the right palm (preductal) and right sole (postductal) in the preterm infants, and to discuss whether the conventional frequency mechanical ventilation (MV) mode has an effect on it, and to clarify the correlation between the respiratory severity score (RSS) and PI.Methods: The preterm infants with the gestational age (GA) ≥32 weeks and body weight (BW) ≥1 500 g who were born with respiratory distress and underwent noninvasive assisted ventilation therapy, with pulse oxygen saturation (SpO2)<90%, requiring conventional frequency MV assistance, were selected. A total of 55 patients met the inclusion criteria were included. The extubation was carried out after meeting the criteria 24 h after birth. The median values within 30 s after stabilization of PI in the right palm and right sole were recorded before and after extubation. At the same time, the ventilator parameters such as the fraction of inspired oxygen (FiO2) and the mean airway pressure (Pmean) before extubation were recorded. The paired samples t-test was used to compare the differences in PI of the right palm and right sole before and after extubation; multivariate linear regression analysis was used to analyze the correlation between GA, BW, and RSS with the preductal PI of the right palm before extubation and the correlation between FiO2 and Pmean with PI. Results: The PI of the right palm before extubation was lower than after extubation (P<0. 05); the PI of the right sole before extubation was lower than that after extubation (P<0. 05); the linear regression analysis results showed there was no correlation between GA and PI (P>0. 05), there was a positive correlation between BW and PI (b=0. 44, standardized regression coefficient (β)=0. 25, P<0. 05)], and there was a negative correlation between RSS and PI (b=-0. 56, β =-0. 68, P<0. 05), and the regression equation was PI=1. 9+0. 44×BW-0. 56×RSS; the further multivariate linear regression analysis results of the ventilator parameters showed that the ventilator parameters constituting the RSS, FiO2 (;b=-2. 52, β=-0. 27, P<0. 05) and Pmean (b=-0. 39, β=-0. 63, P<0. 05), both showed a linear relationship with PI and they were risk factors for it, and the β value of Pmean was greater than that of FiO2, indicating that the former had a greater impact on PI. Conclusion: The conventional frequency MV mode can affect PI, and RSS under this mode is a risk factor for PI; higher RSS can have an adverse effect on the circulation, and Pmean has a greater impact on PI compared with FiO2. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The Pleth Variability Index (PVI) can guide the approach to hypovolemia, which is sometimes the cause and sometimes the result of major diseases; further studies are needed on this index. Therefore, in the present study, we aimed to evaluate the prognostic value of PVI and its relationship with 28-day mortality. PATIENTS AND METHODS: A total of 158 patients were included. Patients were divided into two groups according to 28-day mortality. Patients who died within 28 days were assigned to Group M (Mortal), while those who survived were included in Group S (Survive). Patients' demographics, definitive diagnosis, arterial blood pressure, fingertip oxygen saturation, PVI, fingertip blood glucose, fever, pulse, shock index, and serum lactate level were recorded. RESULTS: Regarding demographics, no statistically significant difference was found between the two groups in terms of age, gender, and Body Mass Index (BMI) (p=0.356, p=0.966, and p=0.977, respectively). The rate of intubation, the use of vasopressors, Acute Physiology and Chronic Health Evaluation (APACHE) II score, shock index, and PVI values were statistically significantly higher in Group M compared to Group S (for all, p<0.001). Glasgow Coma Score (GCS), Perfusion Index (PI), and length of stay were statistically significantly lower in Group M than in Group S (p<0.001, p<0.001, and p=0.025, respectively). PVI predicted 28-day mortality with 83.8% sensitivity and 97.9% specificity. CONCLUSIONS: PVI, serum lactate level, PI, APACHE II, GCS, and need for vasopressors were independent risk factors for 28-day mortality in the Intensive Care Unit (ICU). PVI and serum lactate have a prognostic value in predicting mortality. [ABSTRACT FROM AUTHOR]

The IKORUS system (Vygon, Écouen, France) allows continuous monitoring of the urethral perfusion index (uPI) using a photoplethysmographic sensor mounted near the base of the balloon of a dedicated urinary catheter. We aimed to test the hypothesis that the uPI decreases during off-pump coronary artery bypass (OPCAB) surgery and to investigate the relationship between the uPI and macrocirculatory variables. Prospective observational study. University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Twenty patients having OPCAB surgery. None. The primary endpoint was changes in the uPI during OPCAB surgery. We additionally investigated associations between the uPI and cardiac output, mean arterial pressure, heart rate, and point-of-care variables. Twenty patients with 24,137 uPI measurements were included. Overall, there was a high interindividual variability in the uPI. Compared with the preparation phase (during which the median [interquartile range] uPI was 7.7 [5.6-12.0]), the uPI decreased by 14% (95% CI 13%-15%) during the bypass grafting phase, by 35% (95% CI 34%-36%) during the cardiac positioning phase, and by 7% (95% CI 6%-9%) during hemostasis. There was no clinically important association between uPI and either cardiac output, mean arterial pressure, or heart rate. The uPI decreases during OPCAB surgery, specifically during the cardiac positioning phase. There was no clinically important association between uPI and either cardiac output, mean arterial pressure, or heart rate. It, therefore, remains to be determined whether intraoperative uPI decreases are clinically important, reflect alterations in intra-abdominal tissue perfusion that are not reflected by systemic macrohemodynamics, and can help clinicians guide therapeutic interventions. [ABSTRACT FROM AUTHOR]

Background and Aims: Short-term hypotension after general anaesthesia can negatively impact surgical outcomes. This study compared the predictive potential of the pleth variability index (PVI), pulse pressure variability (PPV), and perfusion index (PI) for anaesthesia-induced hypotension. This study's primary objective was to evaluate the predictive potential of PI, PVI, and PPV for hypotension. Methods: This observational study included 140 adult patients undergoing major abdominal surgery under general anaesthesia. Mean arterial pressure, heart rate, PVI, PPV, and PI were collected at 1-min intervals up to 20 min post anaesthesia induction. Hypotension was assessed at 5-min and 15-min intervals. Receiver operating characteristic (ROC) curves were plotted to determine the diagnostic performance and best cut-off for continuous variables in predicting a dichotomous outcome. Statistical significance was kept at P < 0.05. Results: Hypotension prevalence within 5 and 15 min of anaesthesia induction was 36.4% and 45%, respectively. A PI cut-off of 11.5, while PPV's AUROC was 0.742 (P = 0.001) at cut-off >12.5. At 15 min, PVI's AUROC was 0.615 (95% confidence interval 0.521–0.708, P = 0.020), with 54.9% positive predictive value and 65.2% negative predictive value. Conclusion: PVI, PPV, and PI predicted hypotension within 5 min after general anaesthesia induction. PVI had comparatively higher accuracy, sensitivity, specificity, and positive predictive value than PI and PPV when predicting hypotension at 15 min.

Background and Objectives: Spinal anesthesia is the technique of choice for elective cesarean section with a prominent side effect of postspinal anesthesia hypotension (PSH). This needs an early prediction to avoid feto-maternal complication. This study aimed to assess the diagnostic accuracy of perfusion index (PI) and inferior vena cava collapsibility index (IVCCI) in the prediction of PSH. Material and Methods: Thirty parturients of American Society of Anesthesiologists Physical Status (ASA-PS) 1 and two undergoing cesarean delivery participated in the study. IVCCI, PI, baseline systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), and heart rate (HR) were noted in the preoperative period. The fall of MBP by 20% from baseline or below 65 mm Hg was considered PSH. After spinal anesthesia, SBP, DBP, MBP, and HR were noted again for diagnosing PSH. Results: It did not show any statistical difference when comparing the PI between the PSH and non-PSH groups in both the PSH definition groups. IVCCI was significantly higher when PSH was considered MBP

Background: Perfusion index (PI) is a somewhat novel parameter evaluating the pulsatility of blood in the extremities, calculated using the infrared spectrum as a component of plethysmography waveform processing. Aims and Objectives: To obtain a cutoff value of pre-anesthesia PI, which may be helpful for the prediction of hypotension following anesthetic induction with propofol. Materials and Methods: This descriptive observational research was carried out at the Sree Gokulam medical college and research foundation, Venjaramoodu, Trivandrum, Kerala, from June 2020 to June 2021. A total of 174 patients of age group 17–60 years, with ASA 1 or 2 scheduled for surgery under general anesthesia, were included. The parameters (systolic blood pressure [SBP], diastolic blood pressure, mean arterial pressure, PI, and SPO2) were recorded until 5 min of induction. Intravenous (IV) fentanyl 2 μg/kg was administered, propofol injected was given slowly at a rate of 10 mg per every 5 s, titrated to loss of verbal communication responseuronium 0.1 mg/kg IV was administered. The calculation for hypertension was done 5 min after anesthesia. The predictive validity of PI was calculated, keeping SBP as the standard gold test. For statistical analysis coGuide software. Results: The cutoff value for PI at 5 min was low (≤2.45) for 27 (90%) participants and high (>2.45) for 3 (10%) participants. With a sensitivity of 90% in predicting hypotension and specificity of 87.50%, false-positive rate was 12.50%, false-negative rate was 10, positive predictive value was 60% (95 CI 44.43–74.30%), the negative predictive value (NPV) was 97.67%, and the total diagnostic accuracy was 87.93%. Conclusion: With the current study’s findings, we conclude that PI cutoff value 2.45 can be used to predict hypotension following anesthetic induction with propofol. It has a high NPV with fair diagnostic accuracy.

ABSTRACTIntroduction The elderly patients are at a greater risk for hypotension after induction of anesthesia. Perfusion index (PI) predicted patients vascular responses in many situations. This study hypothesized that baseline value of PI would predict hypotension in geriatric patients after anesthetic induction as population at risk for postinduction hypotension.Methods This observational, prospective study involved 30 patients aged >65 years who were scheduled for elective procedures under general anesthesia. From baseline to 15 min after propofol induction of anesthesia, the PI, heart rate, and blood pressure (BP) were recorded every minute. Hypotension was defined as a decrease greater than 30% in systolic BP from baseline.Results Early hypotension within 3 min after induction was experienced in 53.3%, while 36.7% had late hypotension within 15 min. Receiver operating characteristic (ROC) curves for PI as a predictive test of hypotension at 3 min showed good predictability of the baseline PI for early postinduction hypotension with area under receiver operating characteristic curve (AUC) 0.97, sensitivity 88%, specificity 93%, positive predictive value (PPV) 93%, negative predictive value (NPV) 87%, and a cutoff value of ≤1.3. After intubation, the predictive value decreased, with PI > 0.91 to predict late hypotension with sensitivity 91%, specificity 58%, PPV 56%, NPV 92%, and AUC 0.66.Conclusions PI could predict early hypotension following propofol induction in the geriatric population. So, it can be considered a valuable tool in monitoring this vulnerable population after induction of anesthesia.

ABSTRACTBackground The most common drawback of spinal anesthesia (SA) is hypotension, which has adverse effects on both mother and fetus; consequently, early detection and management of spinal hypotension have been considered a very important topic in obstetric anesthesia. Additionally, the capability to ultimately diagnose hypotension could permit initiation of adequate treatment. The standard method to estimate blood pressure during cesarean section is noninvasive blood pressure measurement. However, periods of hypotension could be missed within a reasonable time frame.Methods Perfusion index (PI) and blood pressure were measured in 100 pregnant women during elective cesarean section under SA.Results PI had a significant negative correlation with the change occurred in systolic blood pressure (SBP) (r = −.432, p

Post-induction hypotension (PIH) is a common and potentially serious complication of general anesthesia. This meta-analysis (Prospero registration number: CRD42024566321) aimed to evaluate the predictive efficacy of the perfusion index (PI) for PIH in patients undergoing general anesthesia. A comprehensive literature search was performed using multiple electronic databases (Google Scholar, EMBASE, Cochrane Library, and MEDLINE). Studies involving adult patients undergoing general anesthesia, with the PI measured before anesthesia induction and reporting PIH incidence, were included. The primary outcome was the diagnostic accuracy of the PI in predicting the probability of PIH. The secondary outcome was the pooled PIH incidence. Eight studies with 678 patients were included. The pooled incidence of PIH was 44.8% (95% confidence interval [CI]: 29.9%–60.8%). The combined sensitivity and specificity of the PI for predicting PIH were 0.84 (95% CI: 0.65–0.94) and 0.82 (95% CI: 0.70–0.90), respectively. The summary receiver operating characteristic (sROC) analysis revealed an area under curve of 0.89 (95% CI: 0.86–0.92). The Deek’s funnel plot asymmetry test indicated no significant publication bias. The PI demonstrates high predictive efficacy for PIH in patients undergoing general anesthesia, indicating that it can be a valuable tool for identifying those at risk of PIH.

The pulse oximeter, a common device in different hospital areas, especially in critical areas, is used most of the time to assess the patient's respiratory status; however, current evidence shows that this device can provide us with valuable information on hemodynamic behavior, the response of the autonomic nervous system, and the therapy given to critically ill patients. It is for this reason that knowing the fundamentals of oximetry, values beyond oxygenation such as the plethysmographic waveform and the perfusion index results in an important amount of information for decision making and the response to the treatments performed. [ABSTRACT FROM AUTHOR]

Background: Whether peripheral vasodilation or decrease in cardiac output causes the reduction in blood pressure (BP) following induction of anaesthesia, is not clearly understood. Therefore, an attempt was made to elucidate the mechanism of hypotension in terms of change in perfusion index (PI) and cardiac output. Methods: With institutional ethics committee permission and consent, 66 patients were assigned equally to three groups. Each group received a titrated dose of a different induction agent, namely thiopentone (5 mg/kg), propofol (2 mg/kg) or etomidate (0.3 mg/kg). PI, heart rate (HR), and systolic, diastolic and mean arterial pressure were recorded at baseline and then every minute until 10 minutes post intubation. Echocardiography parameters (i.e. ejection fraction (EF), contractility and left ventricular end diastolic volume (LVEDV)) were measured at baseline, three minutes post induction and five minutes post intubation. Statistical analysis included one-way analysis of variance (ANOVA), Bonferroni test or Kruskal Wallis/Mann Whitney-U test. Results: The EF and contractility remained stable after induction with all three induction agents. However, LVEDV and hence stroke volume increased significantly with etomidate (p = 0.011). There was gradual and continued increase in PI and reduction in the BP from the time of induction, which was minimal with etomidate and maximum with propofol. A marginal increase in HR was seen with thiopentone, while others caused a steady fall. Conclusion: Vasodilation and reduced HR were responsible for the hypotension following induction of anaesthesia by intravenous agents. The effect was maximal with propofol with no evidence of myocardial depression. Etomidate lead to increase in stroke volume which explains its cardiovascular stability [ABSTRACT FROM AUTHOR]

BACKGROUND: Monitoring replanted digits remains a challenging task in microsurgical units. Previous studies have indicated the perfusion index (PI), a parameter directly proportional to the blood flow, might be a useful tool. OBJECTIVE: The PI is evaluated as a monitoring tool in patients with replanted digits. METHODS: This prospective, non-interventional study includes 31 patients with revascularized or replanted digits. After successful revascularization or replantation, the PI and peripheral oxygen saturation of the affected finger and its contralateral equivalent were measured simultaneously. The values were detected by the device Radical-97® Pulse CO-Oximeter® (Masimo Corporation, 52 Discovery, Irvine, CA 92618, USA). RESULTS: The median PI of affected fingers was 3.5±0.56 for revascularized and 2.2±0.8 for replanted fingers. The difference between the PI values of replanted digits and the healthy contralateral side was highly significant (p < 0.0001). The area under the curve in the receiver operating characteristics was 0.92 for a PI difference > 80.49% and predicted a loss of replant with a specificity of 100% and a sensitivity of 75%. CONCLUSION: The assessment of the PI in patients with reperfusion of a vascular compromised digit is a useful tool to continuously monitor peripheral perfusion. The dynamic behavior of the PI is essential to detect perfusion disturbance. [ABSTRACT FROM AUTHOR]

Background: Perfusion index (PI) is a somewhat novel parameter evaluating the pulsatility of blood in the extremities, calculated using the infrared spectrum as a component of plethysmography waveform processing. Aims and Objectives: To obtain a cutoff value of pre-anesthesia PI, which may be helpful for the prediction of hypotension following anesthetic induction with propofol. Materials and Methods: This descriptive observational research was carried out at the Sree Gokulam medical college and research foundation, Venjaramoodu, Trivandrum, Kerala, from June 2020 to June 2021. A total of 174 patients of age group 17-60 years, with ASA 1 or 2 scheduled for surgery under general anesthesia, were included. The parameters (systolic blood pressure [SBP], diastolic blood pressure, mean arterial pressure, PI, and SPO2) were recorded until 5 min of induction. Intravenous (IV) fentanyl 2 μg/kg was administered, propofol injected was given slowly at a rate of 10 mg per every 5 s, titrated to loss of verbal communication responseuronium 0.1 mg/kg IV was administered. The calculation for hypertension was done 5 min after anesthesia. The predictive validity of PI was calculated, keeping SBP as the standard gold test. For statistical analysis coGuide software. Results: The cutoff value for PI at 5 min was low (≤2.45) for 27 (90%) participants and high (>2.45) for 3 (10%) participants. With a sensitivity of 90% in predicting hypotension and specificity of 87.50%, false-positive rate was 12.50%, false-negative rate was 10, positive predictive value was 60% (95 CI 44.43-74.30%), the negative predictive value (NPV) was 97.67%, and the total diagnostic accuracy was 87.93%. Conclusion: With the current study's findings, we conclude that PI cutoff value 2.45 can be used to predict hypotension following anesthetic induction with propofol. It has a high NPV with fair diagnostic accuracy. [ABSTRACT FROM AUTHOR]

Background and Objectives: Spinal anesthesia is the technique of choice for elective cesarean section with a prominent side effect of postspinal anesthesia hypotension (PSH). This needs an early prediction to avoid feto-maternal complication. This study aimed to assess the diagnostic accuracy of perfusion index (PI) and inferior vena cava collapsibility index (IVCCI) in the prediction of PSH. Material and Methods: Thirty parturients of American Society of Anesthesiologists Physical Status (ASA-PS) 1 and two undergoing cesarean delivery participated in the study. IVCCI, PI, baseline systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), and heart rate (HR) were noted in the preoperative period. The fall of MBP by 20% from baseline or below 65 mm Hg was considered PSH. After spinal anesthesia, SBP, DBP, MBP, and HR were noted again for diagnosing PSH. Results: It did not show any statistical difference when comparing the PI between the PSH and non-PSH groups in both the PSH definition groups. IVCCI was significantly higher when PSH was considered MBP <65 mm Hg (P = 0.01). However, IVCCI was found to be statistically insignificant if PSH was considered a 20% reduction in baseline MBP. The correlation matrix between IVCCI and PI showed Pearson's r-value of 0.525, indicating a substantial relationship between the two (P = 0.003). Multivariate logistic regression analysis had shown that neither IVCCI nor PI was a good predictor of PSH in parturients for both definition groups for PSH. Conclusion: Although there is a modest correlation between PI and IVCCI, both cannot be used to predict postspinal hypotension in parturients undergoing elective lower-segment cesarean section (LSCS). [ABSTRACT FROM AUTHOR]

Prediction of fluid responsiveness in hypotensive patients is a challenge. The correlation between a novel noninvasive dynamic indicator, Pleth Variability Index (PVI ®), and a gold-standard Systolic Pressure Variation (SPV) as a measure of fluid responsiveness was assessed in the Intensive Care Unit (ICU) or Operation Theatre (OT) in a tertiary care hospital. A prospective experimental study was conducted over a span of one year on 100 mechanically ventilated patients with hypotension. Vital parameters along with SPV and PVI ® were recorded before and after a standard volume expansion protocol. A 10% SPV threshold was used to define fluid responders and nonresponders. Pearson's correlation graph at baseline showed positive correlation between PVI ® and SPV (r = 0.59, p-value = 0.001). Strength of correlation was comparatively less but still showed positive correlation at 15 (r = 0.39, p-value = 0.009) and 30 (r = 0.404, p-value = 0.004) minutes of fluid bolus. The Bland Altman analysis of baseline values of PVI ® and SPV showed good agreement with a mean bias of 9.05. Percentage change of PVI ® and SPV over 30 min showed a statistically significant positive correlation in the responder group (r = 0.53, p < 0.05). A threshold value of PVI ® more than 18% before volume expansion differentiated fluid responders and nonresponders with a sensitivity of 75% and specificity of 67%, with an area under Receiver Operating Characteristic (ROC) of 0.78. A positive correlation exists between SPV and PVI ®, justifying the use of noninvasive PVI ® in a clinical setting of hypotension. [ABSTRACT FROM AUTHOR]

Background: Perfusion index (PI) is a simple, objective, and noninvasive method for evaluating the success of brachial plexus blocks. There is only one study which assessed the time point at which the PI had the best predictive value. Aims: Of the 5 measured outcome variables (i.e.; PI at baseline, at 5 min, at 10 min, and at 15 min and PI ratio), we wanted to determine the one which had the best predictive value for block success. Materials and Methods: It is a prospective observational study done in a tertiary care teaching hospital. Sixty‑nine patients of either sex, American Society of Anesthesiologists Physical Status I and II, between the ages of 18 and 65 years posted for elective upper limb surgery were included. Patients were given supraclavicular blocks with a peripheral nerve stimulator. PI recorded at baseline, 5 min, 10 min, and 15 min. A PI ratio was calculated. Sensory and motor blocks were assessed at 5‑min intervals. Statistical Analysis: Descriptive analysis was applied by mean and standard deviation for quantitative variables and frequency and proportion for categorical variables. Receiver operating characteristic (ROC) curves were constructed. SPSS version 22 was used to detect an area under the ROCs (AUROC) curve and calculated to assess how good a test PI at 10 and 15 min and PI ratio are in predicting the outcome of a block. Results: The mean PI increased continuously from the baseline till 15 min in successful blocks, but in unsuccessful blocks, the rise was not seen. ROC curves showed an AUROC curve of 0.93 in case of PI at 15 min and 0.84 for PI ratio. Conclusion: We conclude that PI at 15 min is the best in our study and PI ratio is the next best as a predictor for evaluating success of supraclavicular blocks. [ABSTRACT FROM AUTHOR]

This work demonstrates for the first time a possibility of assessing changes in the parameters of cortical blood flow in mice through the intact cranial bone during pharmacological tests using the method of imaging photoplethysmography with illumination in the green region of the spectrum. This makes it possible to evaluate the effect of tests on hemodynamics without prior surgical intervention on the skull bones. It has been shown that administration of the nitroglycerin can lead to both an increase in cortical blood flow and a decrease in it, which indicates the duality of the effect of this drug on meningeal vasomotor activity. [ABSTRACT FROM AUTHOR]

A topic of current research is the development of a new approach to the diagnosis and treatment of severe brain injury taking into consideration its main pathophysiological mechanism—idiopathic intracranial hypertension syndrome. The goal of this study was to identify Doppler patterns of unfavorable craniocerebral injury conditions to form a consistent algorithm of treatment measures to reduce secondary brain damage in patients with severe craniocerebral trauma. Transcranial Doppler imaging is a prospective method, which allows quick and noninvasive assessment of the intracerebral blood flow dynamics right at the patient's bedside. Due to the operator-dependent nature of this method, clinical interpretation can often be contradictory. As a result, no clear criteria for therapy correction have yet been formulated based on this neuroimaging method. Analysis of the therapy performed allowed us to specify the options for the hyperosmolar solutions for the correction of idiopathic intracranial hypertension syndrome. No statistically significant difference in effectiveness was shown between mannitol and hypertonic saline solutions. [ABSTRACT FROM AUTHOR]

Introduction: The elderly patients are at a greater risk for hypotension after induction of anesthesia. Perfusion index (PI) predicted patients vascular responses in many situations. This study hypothesized that baseline value of PI would predict hypotension in geriatric patients after anesthetic induction as population at risk for postinduction hypotension. Methods: This observational, prospective study involved 30 patients aged >65 years who were scheduled for elective procedures under general anesthesia. From baseline to 15 min after propofol induction of anesthesia, the PI, heart rate, and blood pressure (BP) were recorded every minute. Hypotension was defined as a decrease greater than 30% in systolic BP from baseline. Results: Early hypotension within 3 min after induction was experienced in 53.3%, while 36.7% had late hypotension within 15 min. Receiver operating characteristic (ROC) curves for PI as a predictive test of hypotension at 3 min showed good predictability of the baseline PI for early postinduction hypotension with area under receiver operating characteristic curve (AUC) 0.97, sensitivity 88%, specificity 93%, positive predictive value (PPV) 93%, negative predictive value (NPV) 87%, and a cutoff value of =1.3. After intubation, the predictive value decreased, with PI > 0.91 to predict late hypotension with sensitivity 91%, specificity 58%, PPV 56%, NPV 92%, and AUC 0.66. Conclusions: PI could predict early hypotension following propofol induction in the geriatric population. So, it can be considered a valuable tool in monitoring this vulnerable population after induction of anesthesia. [ABSTRACT FROM AUTHOR]

Background: The most common drawback of spinal anesthesia (SA) is hypotension, which has adverse effects on both mother and fetus; consequently, early detection and management of spinal hypotension have been considered a very important topic in obstetric anesthesia. Additionally, the capability to ultimately diagnose hypotension could permit initiation of adequate treatment. The standard method to estimate blood pressure during cesarean section is noninvasive blood pressure measurement. However, periods of hypotension could be missed within a reasonable time frame. Methods: Perfusion index (PI) and blood pressure were measured in 100 pregnant women during elective cesarean section under SA. Results: PI had a significant negative correlation with the change occurred in systolic blood pressure (SBP) (r = -.432, p < .0001); by using univariate linear regression analysis, the PI explains 20.2% of variability in SBP as PI significantly predicts the change occurred in SBP (F = 24.8, p < .0001), as each one unit increase in PI, accompanied by a significant decrease in SBP by 2.089 (mm/hg), as (b, t, p) (-2.089, -4.987, .0001), respectively. There was a significant difference in SBP and PI before and after giving oxytocin bolus [(z = -1.9, P = .05) and (z = -4.3, P < .0001), respectively]. By comparing PI before vs. after taking ephedrine bolus, there was a significant decrease in median of PI [median of PI before 10 (5.5-15) vs. median of PI after 7.5 (6-15.5) (z = -6.6, P < .0001)]. Discussion: After SA with sympathetic blockade, peripheral vascular tone declined and therefore PI increased. Conclusion: PI could anticipate the incidence of hypotension during cesarean delivery with SA. Ephedrine effect could be evaluated rapidly by the alteration in the PI so that further need can be judged. Oxytocin has a significant impact on vascular tone with 5 international unit bolus, although it does not have a significant effect on blood pressure. [ABSTRACT FROM AUTHOR]

Objective: Erythrocyte suspension (ES) transfusion is a frequently needed and performed procedure in emergency departments. In this study, the effect of transfusion on the perfusion index (PI), shock index (SI), vital parameters, hemoglobin (Hb), and hematocrit (Hct) values in adult patients who applied to the emergency department and required ES transfusion was investigated. Materials and Methods: Fifty-five adult patients who applied to the emergency medicine clinic within three months and underwent ES replacement were included in the study. The changes in PI, SI, vital parameters, Hb, and Hct values of patients with ES transfusion compared with those pretransfusion were analyzed. Results The mean age of 55 patients included in the study was 62.5±16.5 years, of which 28 (50.9%) were female. Pre-transfusion values of the patients were Hb 6.4±1.2 g/dL, mean arterial pressure (MAP) 83.2±11.6 mmHg, SI 0.73±0. 19, and PI was 3.07±2.21. After the transfusion procedure, Hb was 9.0±1.2 g/dL (p<0.001), MAP 90.0±13.0 mmHg (p<0.001), SI 0.67±0.14 (p=0.003), PI 4.25±3.18 (p=0.004). Conclusion: The ES transfusion procedure causes a statistically significant increase in post-transfusion PI, MAP, Hb, Hct, and body temperature values compared with pre-transfusion, and a statistically significant decrease in mean pulse and SI. PI can be used as a parameter to evaluate treatment response as well as transfusion decisions in patients. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of this study was to observe the changes in pleth variability index (PVI), perfusion index (PI) and other hemodynamic parameters in adult individuals who had had Coronavirus disease 2019 (COVID-19) and were currently living a normal life. A further aim was to draw attention to the fact that some hemodynamic changes after COVID-19 may cause long-term health problems. PATIENTS AND METHODS: A total of 174 adult individuals who had had COVID-19 and were currently living a normal life and 56 healthy individuals with similar demographic characteristics who had not had COVID-19 were included in the study. The PI, PVI, oxygen saturation (SpO2), pulse rate (PR), total hemoglobin (Hgb), oxygen reserve index (ORI), and blood pressure values were measured by Masimo Radical 7. The data of individuals who had and did not have COVID-19 before were compared. RESULTS: The mean PVI (p = 0.008) and PI (p < 0.001) were significantly lower in people who had been exposed to COVID-19. Likewise, the mean of ORI, SpO2, and SpOC values was observed to be significantly lower in participants exposed to COVID-19 disease (p < 0.001, p < 0.001, and p = 0.006, respectively). The PVI had a positive correlation with body mass index (BMI) (r = 0.263, p < 0.001) and a negative correlation with SpO2 (r = -0.194, p = 0.003) and PR (r = 0.190, p = 0.004). CONCLUSIONS: The PVI, PI, and other physiological parameters could potentially be useful for monitoring COVID-19 patients and evaluating their response to therapy. We believe that people who have been exposed to COVID-19 may be more susceptible to other diseases; therefore, they should be subjected to regular clinical checks. [ABSTRACT FROM AUTHOR]

Congenital heart defects (CHDs) are the most common neonatal malformations and are a leading cause of infant death in developed countries. Finding safe and effective diagnostic methods to screen for CHDs is important. The aim of this study was to evaluate the effectiveness of pulse oximetry (PO) and perfusion index (PI) in screening CHD. We conducted a systematic review of studies in PubMed, Embase, and the Cochrane Library published on or before October 1, 2021. Studies based on PICOS were included in this systematic review. The flow chart is made by PRISMA software. The quality of included studies was assessed by RevMan5 software (QUADAS-2: Quality Assessment of Diagnostic Accuracy Studies-2). The sensitivity, specificity, and other measurements of accuracy were pooled using Stata/SE 12.0 software. Five studies containing 46,965 neonates were included in this study. A randomized-effects model was used for the meta-analysis because of significant heterogeneity. The combined sensitivity and specificity were 0.82 (95% confidence interval [CI], 0.53–0.95) and 0.97 (95% CI, 0.57–1.00), respectively. The area under the curve was 0.92 (95% CI, 0.89–0.94). The combination PO and PI was significant in CHD screening. Once diagnosed by the combined method, it means that the neonate is most likely to have a CHD. Key Points Pulse oximetry and PI screening. Congenital heart defects. A systematic review and meta-analysis. [ABSTRACT FROM AUTHOR]

Background Many studies have examined the risk factors for postoperative acute kidney injury (AKI), but few have focused on intraoperative peripheral perfusion index (PPI) that has recently been shown to be associated with postoperative morbidity and mortality. Therefore, this study aimed to evaluate the relationship between intraoperative PPI and postoperative AKI under the hypothesis that lower intraoperative PPI is associated with AKI occurrence. Methods We retrospectively searched electronic medical records to identify patients who underwent surgery at the general surgery department from May 2021 to November 2021. Patient baseline characteristics, pre- and post-operative laboratory test results, comorbidities, intraoperative vital signs, and discharge profiles were obtained from the Institutional Clinical Data Warehouse and VitalDB. Intraoperative PPI was the primary exposure variable, and the primary outcome was postoperative AKI. Results Overall, 2,554 patients were identified and 1,586 patients were included in our analysis. According to Kidney Disease Improving Global Outcomes (KDIGO) criteria, postoperative AKI occurred in 123 (7.8%) patients. We found that risks of postoperative AKI increased (odds ratio: 2.00, 95% CI [1.16, 3.44], P = 0.012) when PPI was less than 0.5 for more than 10% of surgery time. Other risk factors for AKI occurrence were male sex, older age, higher American Society of Anesthesiologists physical status, obesity, underlying renal disease, prolonged operation time, transfusion, and emergent operation. Conclusions Low intraoperative PPI was independently associated with postoperative AKI.

Invasive arterial cannulation is a widely used method in intensive care units and operating rooms. However it has potential complications such as thrombosis, peripheral embolism, hematoma formation, and infection. The Masimo Root Radical-7 Pulse CO-Oximeter® (Masimo Corporation, Irvine, CA, USA) is a non-invasive hemodynamic monitoring device that measures perfusion index and pleth variability index, provides guidance to anaesthesiologists in the cases where hemodynamic fluctuations are expected. In this particular case, the perfusion index played a crucial role in the immediate diagnosis of radial artery embolism in a patient undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy procedure. [ABSTRACT FROM AUTHOR]

Background: The relationship between perfusion index (PI) and organ dysfunction in patients in the intensive care unit (ICU) is not clear. This study aimed to explore the relationship between PI and renal function in the perioperative critical care setting and evaluate the predictive efficiency of PI on patients with acute kidney injury (AKI) in the ICU. Methods: This retrospective analysis involved 12,979 patients who had undergone an operation and were admitted to the ICU in Peking Union Medical College Hospital from January 2014 to December 2019. The distribution of average PI in the first 24 h after ICU admission and its correlation with AKI was calculated by Cox regression. Receiver operating characteristic (ROC) curves were generated to compare the ability of PI, mean arterial pressure (MAP), creatinine, blood urea nitrogen (BUN), and central venous pressure (CVP) to discriminate AKI in the first 48 h in all perioperative critically ill patients. Results: Average PI in the first 24 h served as an independent protective factor of AKI (Odds ratio [OR]=0.786, 95% confidence interval [CI]: 0.704–0.873, P 2.12). Conclusions: As a local blood flow indicator, the initial 24-h average PI for perioperative critically ill patients can predict AKI during their first 120 h in the ICU.

Background. The adverse social situation in Ukraine and an increase in the number of injured children lead to a burden on trauma departments and rehabilitation centers. Looking for simple methods to help detect violations of compensatory mechanisms, one of which is the centralization of blood circulation, and impaired perfusion at the microcirculatory periphery level is of great current relevance. Materials and methods. A comprehensive clinical and functional examinations were applied to 44 children aged 10–15 years, 21 of them had home-related upper extremity fractures (main group), 23 otherwise healthy children served as the control group. All the children underwent the Box and Block Test (BBT), and the perfusion index (PI) from the extremities was recorded. Results. The BBT performance was characterized by a 1.6-fold decrease (p < 0.05) in the affected extremity of children aged 10–15 years under the rehabilitation treatment compared to that of the non-dominant extremity in healthy children and a 1.3-fold decrease (p < 0.05) in the healthy extremity compared to the dominant one. PI decreased to 2.52 ± 0.58 at rest in the main group children who underwent upper extremity rehabilitation treatment for injuries compared to 3.49 ± 0.34 (p < 0.05) in healthy children. PI reduced to 1.57 ± 0.56 in injured children at exercise loads versus 2.93 ± 0.91 (p < 0.05) in healthy children. The dynamics of recovery also differed and amounted to 2.82 ± 0.45 in the main group versus 4.00 ± 0.64 in the control group. Children with PI up to 1.5 ± 0.4 had significantly lower BBT scores at the beginning of exercise training. PI reduction to less than 1.5 allowed predicting a decrease in muscle functions, delayed wound healing, and the need for analgesia. With an increase in PI to 2.40 ± 0.54 during exercise training, children performed BBT better, while those who had a decrease in perfusion up to 0.98 ± 0.20 performed it twice as slowly (p < 0.05). As a study result, an association between the physical exercise load, changes in PI and BBT has been revealed. Conclusions. BBT scores were characterized by a 1.6-, 2.0- and 1.8-fold (p < 0.05) reduction during the first, second and third measurements, respectively, compared to those of healthy children. Characteristic feature of perfusion index was a statistically significant decrease before and during exercise training as well as slow dynamics of recovery. The correlations between perfusion index and BBT have proven the association of the rehabilitation processes and blood flow restoration.

Background: 90% of C-sections are supported by spinal anesthesia, which is complicated by arterial hypotension in 60%-80% of cases. The perfusion index seems to be a significant prognostic tool for arterial hypotension.Objective: Тo confirm the value of perfusion index in predicting arterial hypotension associated with the spinal anesthesia.Materials and methods: The study included 105 female patients who underwent С-section under spinal anesthesia. A decrease in mean arterial pressure by ≤ 20% was considered as arterial hypotension. Baseline perfusion index was assessed with a pulse oximeter. Results: 68 patients (64.8%) developed arterial hypotension in the intraoperative period. In 37 (35.2%) parturient women there were no significant changes in blood pressure. A cut-off threshold of 3.1 with 75% sensitivity and 75% specificity was obtained with the ROC analysis. Arterial hypotension developed in 29.4% (n = 15) of parturient women with a perfusion index < 3.1 and in 72.2% (n = 39) of parturient women with a perfusion index > 3.1.Conclusions: We can use the perfusion index threshold of 3.1 to identify parturient women with an increased risk of arterial hypotension associated with the spinal anesthesia for C-section. The arterial hypotension rate is significantly higher in women with an initial perfusion index > 3.1 compared with those with an initial perfusion index < 3.1.

Abstract Background Dexmedetomidine, one of the sedatives, has an analgesic effect. We aimed to investigate postoperative analgesia with dexmedetomidine as adjuvants for procedural sedation using perfusion index (PI). Methods In this prospective, randomized, case-control, observational study, 72 adult patients, 19–70 years, who were scheduled for chemoport insertion under monitored anesthesia care were performed. According to the group assignment, remifentanil or dexmedetomidine was simultaneously infused with propofol. The primary outcome was PI 30 min after admission to the post anesthesia care unit (PACU). And, pain severity using numerical rating scale (NRS) score and the relationship between NRS score and PI were investigated. Results During PACU staying, PI values were significantly different between the two groups PI values at 30 min after admission to the PACU were 1.3 (0.9–2.0) in the remifentanil group and 4.5 (2.9–6.8) in the dexmedetomidine group (median difference, 3; 95% CI, 2.1 to 4.2; P

Abstract Background Brachial plexus block is one of the peripheral nerve blocks commonly used in regional anesthesia. We aimed to investigate whether the perfusion index (PI) measurement can be used to evaluate the adequacy of the upper limb blocks accompanied by ultrasonography. Thirty-three patients between the ages of 18 and 65 who were in the ASA I–II group who will have a hand, forearm, and arm operation were included in the study. An appropriate type of brachial plexus block was applied to these patients under the guidance of ultrasonography. After the block application was completed, the sensory and motor blocks were evaluated at the 5th, 10th, and 20th min. In addition, perfusion indices measured from both extremities of the patient were recorded at the 5th, 10th, and 20th min. Results In 32 of 33 patients who underwent brachial plexus block, our block was successful, and perfusion index measurements in the applied limb increased continuously from the 5th min over the 20-min observation period. In one patient who failed the block and in the arm group without block, no statistically significant difference was detected in the 5th, 10th, and 20th min perfusion index measurements. Conclusions Perfusion index measurement is a very valuable and usable method to evaluate the success of peripheral nerve blocks early, easily, and objectively.

Background: The perfusion index (PI) is an objective method used to determine a successful nerve block. This study aimed to investigate the prognostic ability of the PI for a successful adductor canal nerve block (ACB) and suggest the optimal PI cut-off value for predicting a block. Methods: This study was a prospective observational study and enrolled a total of 39 patients. The patients were dichotomized into successful and inappropriate ACB groups according to the results of the sensation tests. The PI value, Pleth variability index (PVi) value, and heart rate were recorded one minute before the block, at the time of the block, and one to 30 min after the block at one-minute intervals. Delta (dPI), which was defined as the difference in PI value from the baseline (the value one minute before the block), was the primary outcome. The area under the receiver operating characteristic curve (AUROC) was calculated to determine the dPI prognostic accuracy and optimal cut-off value. Results: Successful ACB was achieved in 33 patients, while ACB was inappropriate in six patients. The dPI showed significant differences between the two groups under the time interval measured (p = 0.001). The dPI at 5 and 20 min showed good prognostic ability for a successful block, with optimal cut-off values of 0.33 (AUROC: 0.725, 95% CI 0.499–0.951) and 0.64 (AUROC: 0.813, 95% CI 0.599–1.000), respectively. Conclusions: The dPI is an effective predictor of successful ACB. The suggested dPI cut-off values at 5 and 20 min were below 0.33 and 0.64, respectively. [ABSTRACT FROM AUTHOR]