Abstract
BackgroundThe main mechanism of body temperature decrease during cesarean delivery under spinal anesthesia 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 the change in peripheral vascular tone. This study aimed to examine whether preoperative toe PI could predict the decrease in core temperature induced by spinal anesthesia during cesarean delivery.MethodsParturients 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 3 M™ 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.ResultsForty-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%.ConclusionsLow 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 registrationUMIN Clinical Trials Registry (registry number: UMIN000037965).
Highlights
The main mechanism of body temperature decrease during cesarean delivery under spinal anesthesia is core-to-peripheral redistribution of body heat, attributable to vasodilation
Our study aimed to examine whether preoperative toe Perfusion index (PI) could predict the decrease in core temperature induced by spinal anesthesia during cesarean delivery
In the generalized additive model (GAM), there was a small decrease in core temperature when preoperative toe PI was greater than 2.0 to 3.0%. In this prospective cohort study, we demonstrated that low preoperative toe PI was associated with the decrease in core temperature induced by spinal anesthesia during cesarean delivery
Summary
The main mechanism of body temperature decrease during cesarean delivery under spinal anesthesia is core-to-peripheral redistribution of body heat, attributable to vasodilation. This study aimed to examine whether preoperative toe PI could predict the decrease in core temperature induced by spinal anesthesia during cesarean delivery. Spinal and epidural anesthesia cause body heat redistribution by vasodilation below the level of neuraxial sensory blockade [1]. Neuraxial techniques decrease the vasoconstriction and shivering thresholds even above the level of the sensory block, and directly block the efferent nerves that control vasoconstriction and shivering in the lower body [1]. Several clinical studies have been conducted to preoperatively identify parturients at high risk of perioperative body temperature decrease and hypothermia during cesarean delivery; the results remain unclear [8]
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call