Association between Preoperative Toe Perfusion Index and Maternal Core Temperature Decrease during Cesarean Delivery Under Spinal Anesthesia: A Prospective Cohort Study

Abstract

Background: The main mechanism of temperature decrease during spinal anesthesia for cesarean delivery is core-to-peripheral redistribution of body heat, attributable to vasodilation. Perfusion index (PI) obtained with a pulse oximeter helps to assess peripheral perfusion dynamics by detecting changes in peripheral vascular tone. This study aimed to examine whether preoperative toe PI could predict spinal anesthesia-induced core temperature decrease during cesarean delivery.Methods: Parturients undergoing scheduled cesarean delivery under combined spinal-epidural anesthesia from September 2019 to March 2020 were enrolled in this single-center prospective cohort study. All parturients received 0.5% hyperbaric bupivacaine (10 mg) with fentanyl (15 µg) intrathecally. A pulse oximeter probe was placed on the left second toe for continuous PI measurement. The 3M™ Bair Hugger™ Temperature Monitoring System placed over the right temporal region was used to record core temperature over time. We evaluated the association between the maximum core temperature decrease, which is the primary outcome, and the preoperative toe PI at operating room (OR) admission using a segmented regression model (SRM) and a generalized additive model (GAM). The maximum core temperature decrease was defined as the difference between core temperature at OR admission and minimum intraoperative core temperature.Results: Forty-eight patients were evaluated. In the SRM, the slope for the association between the maximum core temperature decrease and the preoperative toe PI changed from 0.031 to 0.124 after PI = 2.4%. Likewise, with the GAM, there was a small core temperature decrease when preoperative toe PI was greater than 2.0% to 3.0%.Conclusions: A lower preoperative toe PI was associated with maternal core temperature decrease during cesarean delivery under spinal anesthesia. Preoperative toe PI is a simple, non-invasive, and effective tool for the early prediction of perioperative core temperature decrease during cesarean delivery.Trial registration: UMIN Clinical Trials Registry (registry number: UMIN000037965).URL: https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000042953

Relationship between perfusion index and central temperature before and after induction of anesthesia in laparoscopic gastrointestinal surgery: A prospective cohort study

“…This is consistent with previous reports, which state that PI is associated with central temperature and correlated with intraoperative peripheral temperature and the peripheral central temperature gradient during cesarean section. [10,[18][19][20] Thus, it may be possible to estimate and prevent redistribution hypothermia at 30 and 60 minutes after anesthesia induction by managing body temperature according to the baseline PI before and PI ratio of variation at 30 minutes before and after anesthesia induction, respectively. This result regarding perioperative body temperature management can be considered novel, and we aim to formulate a body temperature management protocol to be followed during the induction of general anesthesia.…”