Comparison of Pleth Variability Index vs. Diastolic Shock Index for Predicting Hypotension During Anesthesia Induction

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

126 participants

Study Classification

OBSERVATIONAL

Study Start Date

2024-08-08

Study Completion Date

2025-03-15

Brief Summary

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This study aims to explore the frequent occurrence of hypotension during anesthesia induction due to anesthetic drugs or fasting. Predicting this condition is important for patient safety and anesthesia management. The study examines two indices: the Pleth Variability Index (PVI), derived from pulse oximeter readings, and the Diastolic Shock Index (DSI), calculated using heart rate and diastolic blood pressure. While PVI is a well-known method, DSI has been less explored in predicting anesthesia-related hypotension. The study aims to compare the effectiveness of these two indices in forecasting hypotension during anesthesia induction.

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Detailed Description

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Hypotension is frequently observed during anesthesia induction due to the effects of anesthetic drugs on hemodynamics and the requirement of a specific fasting period before surgery. Induction-related hypotension can lead to decreased tissue perfusion and, consequently, secondary organ damage. Predicting anesthesia-induced hypotension in advance contributes to better anesthesia management and patient safety (1). Induction-related hypotension is defined as arterial hypotension occurring within the first 20 minutes after anesthesia induction or until the start of the surgery. Arterial hypotension is identified when mean systolic arterial pressure (MAP) decrease \> 20% or MAP \<65 mmHg or when norepinephrine is administered at a dose \>;6 mcg/min at least once during this period (2).

The peripheral perfusion index (PI) is a simple, cost-effective monitoring method derived from non-invasive plethysmographic data using pulse oximetry. It provides an assessment of fluid status based on respiratory changes in pulse oximeter waves, with higher PI values indicating lower arterial tone. Changes in PI are interpreted as signs of vascular tone or fluid deficit issues in patients. The ratio of the highest and lowest PI values yields the Pleth Variability Index (PVI) (3,4). PVI can be used to predict hypotension during anesthesia induction (5).

Cardiac output (CO) is calculated by multiplying systemic vascular resistance (SVR) and heart rate (HR). In septic and shock patients, CO may be low, often due to decreased SVR. The autonomic system tries to maintain CO by increasing HR in response to the reduced SVR (6). Systolic and diastolic shock indices are obtained by dividing the HR by systolic and diastolic blood pressures, respectively. The diastolic shock index has been evaluated in studies to predict vasopressor response in septic patients (7). A high shock index has been associated with early vasopressor initiation and better prognosis. However, no study has yet examined the predictive power of the diastolic shock index, which is related to sympathetic response and systemic vascular resistance, for hypotension following anesthesia induction.

Moreover, the diastolic shock index has not been compared with the more commonly used PVI in terms of their ability to predict hypotension. Therefore, our study aims to test the success of diastolic shock index and PVI measurements in predicting anesthesia-induced hypotension

Conditions

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Anesthesia Induced Hypotension Hypotension Drug-Induced

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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General Anesthesia Group

This group includes all study patients who underwent elective lumbar spine surgery under general anesthesia. In these patients, both PVI and DSI measurements will be performed before and during anesthesia induction.

Pulse variability index measurement

Intervention Type DIAGNOSTIC_TEST

Peripheral perfusion index (PI) is an easy-to-implement and low-cost monitoring procedure obtained by interpreting non-invasive data obtained from pulse oximetry via plethysmography. It is a tool that allows interpretation of fluid status through changes in pulse oximetry waves caused by respiration. High perfusion indices are interpreted as low arterial tone. Changes in perfusion index are interpreted as indicators of vascular tone or fluid deficit problems in patients. The ratio of the highest and lowest PI values gives the Pleth Variability Index (PVI) (3,4). Hypotension can be predicted during anesthesia induction with PVI

Diastolic shock index

Intervention Type OTHER

The Diastolic Shock Index (DSI) is a hemodynamic parameter calculated by dividing the heart rate (HR) by the diastolic blood pressure (DBP). It reflects the balance between cardiac output and systemic vascular resistance, particularly in critically ill patients. A higher DSI can indicate impaired vascular resistance and may be useful for predicting the need for vasopressor support, especially in conditions like septic shock. However, its application in predicting hypotension during anesthesia induction is still under investigation.

Interventions

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Pulse variability index measurement

Peripheral perfusion index (PI) is an easy-to-implement and low-cost monitoring procedure obtained by interpreting non-invasive data obtained from pulse oximetry via plethysmography. It is a tool that allows interpretation of fluid status through changes in pulse oximetry waves caused by respiration. High perfusion indices are interpreted as low arterial tone. Changes in perfusion index are interpreted as indicators of vascular tone or fluid deficit problems in patients. The ratio of the highest and lowest PI values gives the Pleth Variability Index (PVI) (3,4). Hypotension can be predicted during anesthesia induction with PVI

Intervention Type DIAGNOSTIC_TEST

Diastolic shock index

The Diastolic Shock Index (DSI) is a hemodynamic parameter calculated by dividing the heart rate (HR) by the diastolic blood pressure (DBP). It reflects the balance between cardiac output and systemic vascular resistance, particularly in critically ill patients. A higher DSI can indicate impaired vascular resistance and may be useful for predicting the need for vasopressor support, especially in conditions like septic shock. However, its application in predicting hypotension during anesthesia induction is still under investigation.

Intervention Type OTHER

Other Intervention Names

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PVI DSI

Eligibility Criteria

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Inclusion Criteria

1. Patients with a preoperative fasting period of at least 6 hours
2. Patients scheduled for elective surgery under general anesthesia
3. Patients aged 18-65 with ASA classification I-III
4. Patients undergoing lumbar spinal surgery

Exclusion Criteria

1. Patients who do not agree to participate in the study
2. Emergency surgeries
3. Patients who will undergo surgery under spinal anesthesia
4. Patients diagnosed with autonomic neuropathy
5. Patients undergoing surgery with inotropic support

Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No