Öz
Aim: The relative variability in the perfusion index (PI) observed after anesthesia induction, due to the effect of surgical positions, is influenced by multiple factors. The aim of this study was to investigate changes in PI in patients undergoing surgery in the supine, prone, and sitting positions, and to assess the effect of body mass index (BMI) on the relative change in PI (ΔPI).
Material and Methods: This is a prospective cross-sectional observational study. A total of 82 patients were enrolled between June 2023 and December 2023, including individuals over 18 years of age. The study investigated the effects of different patient positions (supine, sitting, and prone) and BMI on the relative change in perfusion index.
Results: Of the patients, 52.4% were male (n = 43). It was found that 43.9% of the patients had a BMI greater than 25 kg/m² (n = 36). The operations were performed in the prone position in 32.9% of cases (n = 27), supine position in 32.9% (n = 27), and sitting position in 34.1% (n = 28). No statistically significant difference was observed in the PI value at 0 minutes across all groups. The PI values at 10, 20, and 30 minutes were highest in Group 1 patients. It was found that the PI values were statistically higher in patients with a BMI <25 at all time intervals (p < 0.001). The ability of a BMI of 25 or greater to predict ΔPI after anesthesia induction was analysed, and the area under the ROC curve showed a sensitivity of 91% and specificity of 93%. The cut-off value, according to the maximum Youden index, was 0.96, with a confidence interval of 91-99% (p < 0.001). Conclusion: The change in the PI value after anesthesia induction was found to be greater in patients positioned prone. This change significantly impacts ΔPI, particularly when the BMI ≥ 25 cut-off is applied.
Anahtar Kelimeler
Etik Beyan
This study is approved by Amasya University Institution's Ethics Committee (2023000046-1).
Destekleyen Kurum
The authors declared that this study has received no financial support.
Kaynakça
- Holte K, Foss NB, Svensén C, Lund C, Madsen JL, Kehlet H. Epidural anesthesia, hypotension, and changes in intravascular volume. Anesthesiol 2024; 100: 281-6.
- Taylor CR, Dominguez JE, Habib AS. Obesity And Obstetric Anesthesia: Current Insights. Local Reg Anesth 2019; 12: 111-24.
- Nihiser AJ, Lee SM, Wechsler H, McKenna M, Odom E, Reinold C et al. Body mass index measurement in schools. J Sch Health 2007; 77: 651-71; quiz 722-4.
- Wellens RI, Roche AF, Khamis HJ, Jackson AS, Pollock ML, Siervogel RM. Relationships between the Body Mass Index and body composition. Obes Res 1996; 4: 35-44.
- Abdelhamid B, Yassin A, Ahmed A, Amin S, Abougabal A. Perfusion index-derived parameters as predictors of hypotension after induction of general anesthesia: a prospective cohort study. Anesthesiol Intense Ther 2022; 54: 34-41.
- Elshal MM, Hasanin AM, Mostafa M, Gamal RM. Plethysmographic Peripheral Perfusion Index: Could It Be a New Vital Sign? Front Med (Lausanne) 2021; 8: 651909.
- Chevalier G. Changes in pulse rate, respiratory rate, blood oxygenation, perfusion index, skin conductance, and their variability induced during oath after grounding people subjects for 40 minutes. J Alternat Oath Comp Med 2010; 16: 81-7.
- Min JY, Chang HJ, Chu SJ, Chung MY. The Perfusion Index of the Ear as a Predictor of Hypotension Following the Induction of Anesthesia in Patients with Hypertension: A Prospective Observational Study. J Clin Med 2022; 27; 11: 6342.
- Sun X, He H, Xu M, Long Y. Peripheral perfusion index of pulse oximetry in adult patients: a narrative review. Eur J Med Res 2024; 11; 29: 457.
- Sun S, Huang SQ. Role of pleth variability index for predicting hypotension after spinal anesthesia for cesarean section. Int J Obstet Anesth 2014; 23: 324-9.
- Smith JJ, Porth CM, Erickson M. Hemodynamic response to the upright posture. J Clin Pharmacol 1994; 34: 375-86.
- Tapar H, Karaman S, Dogru S, Karaman T, Sahin A, Tapar GG, Altiparmak F, Suren M. The effect of patient positions on perfusion index. BMC Anesthesiol 2018; 17; 18: 111.
- Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of Obesity Among Adults and Youth: United States, 2015-2016. NCHS Data Brief 2017; 288: 1-8.
- Shen Q, Hiebert JB, Rahman FK, Krueger KJ, Gupta B, Pierce JD. Understanding Obesity-Related High Output Heart Failure and Its Implications. Int J Heart Fail 2021; 3: 160-171.
- Abel ED, Litwin SE, Sweeney G. Cardiac remodeling in obesity. Physiol Rev 2008; 88: 389-419.
- Sun M, Tan Y, Rexiati M, Dong M, Guo W. Obesity is a common soil for premature cardiac aging and heart diseases - Role of autophagy. Biochim Biophys Acta Mol Basis Dis 2019; 1865: 1898-904.
Fazla kilo ve hasta pozisyon değişikliklerinin anestezi indüksiyonundan sonra perfüzyon indeksi üzerindeki etkisi
Öz
Amaç: Anestezi indüksiyonundan sonra cerrahi pozisyondaki değişiklikle gözlenen perfüzyon indeksi (PI) değerindeki değişiklik birçok faktörden etkilenir. Bu çalışmanın amacı sırtüstü, yüzüstü ve oturma pozisyonlarında ameliyat edilen hastalarda PI'daki değişikliği ve vücut kitle indeksinin (VKİ) PI'daki (ΔPI) bağıl değişiklik üzerindeki etkisini araştırmaktır. Gereç ve Yöntemler: Bu prospektif kesitsel gözlemsel bir çalışmadır. Haziran 2023 ile Aralık 2023 arasında 18 yaş üstü, sırtüstü, oturma ve yüzüstü pozisyonlarda olmak üzere toplam 82 hasta kaydedildi ve hasta pozisyon değişiklikleri ve VKİ değerlerinin ΔPI üzerindeki etkileri araştırıldı.
Bulgular: Hastaların %52,4'ünün erkek olduğu (n: 43) görüldü. Hastaların %43,9’unun (n:36) BKİ’sinin 25 kg/m2’nin üzerinde olduğu görülmüştür. Cerrahi operasyonlar %32,9 yüzüstü pozisyonda (n:27), %32,9 sırtüstü pozisyonda (n:27) ve %34,1 oturur pozisyonda (n:28) gerçekleştirilmiştir. Tüm gruplarda PI 0 değerinde istatistiksel olarak anlamlı bir fark olmadığı görülmektedir. PI 10-20-30 değerinin grup 1 hastalarında en yüksek düzeyde olduğu görülmektedir. Tüm zaman aralıklarında BKİ <25 olan hasta gruplarında PI değerlerinin istatistiksel olarak daha yüksek olduğu görülmektedir (p<0,001). BKİ 25 olan hastaların anestezi indüksiyonu sonrası ΔPI’yi tahmin etme yeteneği incelendiğinde, ROC eğrisi altında kalan alanın duyarlılığı %91, özgüllüğü ise %93 olarak bulunmuştur. Maksimum Youden indeksine göre kesme değeri %91-99 güven aralığıyla 0,96'dır (p<0,001).
Sonuç: Anestezi indüksiyonundan sonra PI'deki bağıl değişimin yüzüstü pozisyondaki hastalarda daha yüksek olduğu bulunmuştur. BMI≥25 kesme değeri kabul edilirse bu değişim ΔPI'yi yüksek oranda etkiler.
Anahtar Kelimeler
Kaynakça
- Holte K, Foss NB, Svensén C, Lund C, Madsen JL, Kehlet H. Epidural anesthesia, hypotension, and changes in intravascular volume. Anesthesiol 2024; 100: 281-6.
- Taylor CR, Dominguez JE, Habib AS. Obesity And Obstetric Anesthesia: Current Insights. Local Reg Anesth 2019; 12: 111-24.
- Nihiser AJ, Lee SM, Wechsler H, McKenna M, Odom E, Reinold C et al. Body mass index measurement in schools. J Sch Health 2007; 77: 651-71; quiz 722-4.
- Wellens RI, Roche AF, Khamis HJ, Jackson AS, Pollock ML, Siervogel RM. Relationships between the Body Mass Index and body composition. Obes Res 1996; 4: 35-44.
- Abdelhamid B, Yassin A, Ahmed A, Amin S, Abougabal A. Perfusion index-derived parameters as predictors of hypotension after induction of general anesthesia: a prospective cohort study. Anesthesiol Intense Ther 2022; 54: 34-41.
- Elshal MM, Hasanin AM, Mostafa M, Gamal RM. Plethysmographic Peripheral Perfusion Index: Could It Be a New Vital Sign? Front Med (Lausanne) 2021; 8: 651909.
- Chevalier G. Changes in pulse rate, respiratory rate, blood oxygenation, perfusion index, skin conductance, and their variability induced during oath after grounding people subjects for 40 minutes. J Alternat Oath Comp Med 2010; 16: 81-7.
- Min JY, Chang HJ, Chu SJ, Chung MY. The Perfusion Index of the Ear as a Predictor of Hypotension Following the Induction of Anesthesia in Patients with Hypertension: A Prospective Observational Study. J Clin Med 2022; 27; 11: 6342.
- Sun X, He H, Xu M, Long Y. Peripheral perfusion index of pulse oximetry in adult patients: a narrative review. Eur J Med Res 2024; 11; 29: 457.
- Sun S, Huang SQ. Role of pleth variability index for predicting hypotension after spinal anesthesia for cesarean section. Int J Obstet Anesth 2014; 23: 324-9.
- Smith JJ, Porth CM, Erickson M. Hemodynamic response to the upright posture. J Clin Pharmacol 1994; 34: 375-86.
- Tapar H, Karaman S, Dogru S, Karaman T, Sahin A, Tapar GG, Altiparmak F, Suren M. The effect of patient positions on perfusion index. BMC Anesthesiol 2018; 17; 18: 111.
- Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of Obesity Among Adults and Youth: United States, 2015-2016. NCHS Data Brief 2017; 288: 1-8.
- Shen Q, Hiebert JB, Rahman FK, Krueger KJ, Gupta B, Pierce JD. Understanding Obesity-Related High Output Heart Failure and Its Implications. Int J Heart Fail 2021; 3: 160-171.
- Abel ED, Litwin SE, Sweeney G. Cardiac remodeling in obesity. Physiol Rev 2008; 88: 389-419.
- Sun M, Tan Y, Rexiati M, Dong M, Guo W. Obesity is a common soil for premature cardiac aging and heart diseases - Role of autophagy. Biochim Biophys Acta Mol Basis Dis 2019; 1865: 1898-904.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Anesteziyoloji |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Haziran 2025 |
| Gönderilme Tarihi | 8 Nisan 2025 |
| Kabul Tarihi | 28 Mayıs 2025 |
| Yayımlandığı Sayı | Yıl 2025 Cilt: 16 Sayı: 2 |
Kaynak Göster
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