Pulse oximetry–derived pleth variability index can predict dexmedetomidine-induced changes in blood pressure in spontaneously breathing patients - 12/10/16
: Clinical Fellow, Takayuki Kunisawa, MD, PhD : Professor, Atsushi Kurosawa, MD : Associate Professor, Tomoki Sasakawa, MD, PhD : Senior LecturerAbstract |
Study objective |
Hypertension or hypotension in patients receiving continuous infusions of dexmedetomidine (DEX) is often due to changes in vascular resistance caused by α2 receptor stimulation. We investigated whether baseline perfusion index (PI) and pleth variability index (PVI), derived from pulse oximetry readings, could predict DEX-induced changes in the hemodynamic status in spontaneously breathing patients.
Design |
Observational study.
Setting |
Operating room.
Patients |
Patients (American Society of Anesthesiologists performance status 1 or 2) scheduled to undergo lower extremity or abdominal procedures under regional anesthesia were approached.
Interventions |
The PI and PVI were set as baseline upon arrival in theater and were then measured at 2.5-minute intervals. Upon attaining stable hemodynamic status under spontaneous breathing, intravenous administration of DEX was initiated at 6 μg kg−1 h−1 for 10minutes, followed by continuous infusion at 0.6 μg kg−1 h−1.
Measurements |
Blood pressure, heart rate, PI, and PVI were measured. Hypertension was defined as an increase in systolic blood pressure (SBP) >15% and hypotension as a decrease in SBP <15% from baseline.
Main results |
Baseline PI and PVI correlated with the degree of change in SBP. The maximum percentage increase as well as the maximum percentage of decrease in SBP from baseline correlated with baseline PI (r=0.418 [P=.005] and r=0.507 [P<.001], respectively) and PVI (r=−0.658 [P<.001] and r=−0.438 [P=.003], respectively). PVI <15 identified DEX-induced hypertension (sensitivity 94%, specificity 85%) and PVI >16 identified DEX-induced hypotension (sensitivity 83%, specificity 64%).
Conclusions |
PVI may predict DEX-induced changes in blood pressure in spontaneously breathing patients.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Dexmedetomidine (DEX) loading can cause transient hypertension or hypotension. |
• | No useful and objective indicators of DEX-induced hemodynamic changes have been found to date. |
• | PI and pleth variability index derived from pulse oximetry were useful to detect DEX-induced hemodynamic changes. |
Keywords : Blood pressure, Dexmedetomidine, Pleth variability index
Plan
| ☆ | Conflicts of interest: The authors declare no conflicts of interest. |
| ☆☆ | Disclosures: The paper's abstract was published in “Anesthesiology® 2015 Annual Meeting Abstract Website”: Hyperlink: abstract.htm;jsessionid=68A51D2FD1C16AF64D06A3D42EAAF23A?year=2015&index=8&absnum=3065 |
Vol 34
P. 318-324 - novembre 2016 Retour au numéro
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