Rajan Karthika, Dave Nandini, Dias Raylene, Muneshwar Priyanka, Kesarkar Nikhil, Saxena Vishal
Senior Resident, Department of Paediatric Anaesthesiology, Seth GS Medical College and KEM Hospital, Mumbai, India.
Senior Consultant and Head of Department, Department of Anaesthesiology, SRCC Children's Hospital, Mumbai, India.
J Anaesthesiol Clin Pharmacol. 2022 Oct-Dec;38(4):635-639. doi: 10.4103/joacp.JOACP_34_21. Epub 2022 Dec 26.
Advances in pulse oximeter technology have enabled us to measure parameters such as perfusion index (PI). We aimed to ascertain the utility of PI in the lower limb for evaluating the onset and adequacy of the pediatric caudal block under general anesthesia. The primary objective was to monitor PI trends after caudal block. The secondary objective was to compare the role of PI, heart rate (HR), and mean arterial pressure (MAP) in detecting onset and adequacy of caudal block and to ascertain whether PI was an earlier indicator in detecting adequate block.
Twenty-five children between 1 and 6 years, who underwent general anesthesia (GA) with caudal block were included. Baseline PI, HR, and MAP were recorded prior to and post caudal block at 5, 10, 15, 20 min and on skin incision. The onset of adequate block was defined as 100% increase of PI from baseline, 15% decrease of MAP or HR from baseline. T-test was used to compare trends of PI with baseline and the number of patients who met or failed these criteria for each of these three parameters at various time intervals wasnoted.
PI increased at all time intervals in 23 of 25 patients with working caudal block ( < 0.0001). By 10 min all those with a working caudal showed a 100% increase in PI. In contrast, 15% decrease in HR was not attained until 15 min where only 8 out of 23 achieved the above criteria, reaching a maximum of 20 patients at the time of incision; a 15% decrease in MAP was observed only in one patient at 5 min, reaching a maximum of eight patients at the time of incision.
PI is an earlier and more sensitive indicator of the onset of the caudal block under general anesthesia (GA) than HR and MAP.
脉搏血氧仪技术的进步使我们能够测量诸如灌注指数（PI）等参数。我们旨在确定下肢PI在评估全身麻醉下小儿骶管阻滞的起效和充分性方面的效用。主要目标是监测骶管阻滞后PI的变化趋势。次要目标是比较PI、心率（HR）和平均动脉压（MAP）在检测骶管阻滞的起效和充分性方面的作用，并确定PI是否是检测阻滞充分的早期指标。
纳入25例1至6岁接受全身麻醉（GA）并实施骶管阻滞的儿童。在骶管阻滞前后5、10、15、20分钟以及皮肤切开时记录基线PI、HR和MAP。阻滞充分起效的定义为PI较基线增加100%，MAP或HR较基线降低15%。采用t检验比较PI与基线的变化趋势，并记录在各个时间间隔达到或未达到这三个参数各自标准的患者数量。
25例骶管阻滞有效的患者中有23例在所有时间间隔PI均升高（<0.0001）。到10分钟时，所有骶管阻滞有效的患者PI均升高了100%。相比之下，直到15分钟时HR才降低15%，此时23例中只有8例达到上述标准，在切开时最多有20例达到；MAP降低15%仅在1例患者于5分钟时出现，在切开时最多有8例达到。
与HR和MAP相比，PI是全身麻醉（GA）下骶管阻滞起效的更早且更敏感的指标。
