Key result
Perfusion index change from supine to semi-recumbent predicts post-induction hypotension with an AUC of ~0.82.
Why the study?
Post-induction hypotension is a common complication of general anesthesia, and whether change in perfusion index between supine and 45° semi-recumbent positions can predict it was unknown.
Does the change in perfusion index between supine and 45° semi-recumbent positions predict post-induction hypotension in adults undergoing elective general anesthesia?
Observational (n=96)
No
Does the change in perfusion index between supine and 45° semi-recumbent positions predict post-induction hypotension in adults undergoing elective general anesthesia?
Effect estimate: OR 1.126 (95% CI 1.036-1.224)
p-value: p=0.005
A change in perfusion index greater than 22.0% between supine and 45° semi-recumbent positions is a reliable predictor of post-induction hypotension during general anesthesia.
May warrant enhanced monitoring or prophylaxis for post-induction hypotension; extends perfusion index evidence but leaves open broader validation.
Post-induction hypotension (PIH) is a common complication during general anesthesia. Perfusion index (PI), a non-invasive indicator reflecting peripheral tissue perfusion and hemodynamic status, has shown potential predictive value for PIH. We hypothesized that the change of PI (ΔPI) between supine and 45° semi-recumbent positions can predict PIH in patients undergoing elective general anesthesia, and a cut-off value of ΔPI for identifying a higher risk of PIH can be determined. This prospective observational study enrolled eligible adults with American Society of Anesthesiologists (ASA) physical status I–III undergoing elective surgery under general anesthesia. Before anesthesia induction, the PI of each patient was recorded after a period of supine rest to achieve hemodynamic stability; subsequently, PI was measured again after achieving stability in the 45° semi-recumbent position. ΔPI between the two positions was calculated for analysis. PIH was defined as systolic blood pressure (SBP) $$<90$$ mmHg, mean arterial pressure (MAP) $$<65$$ mmHg, or a reduction in MAP by $$>30%$$ from baseline within 15 minutes after anesthesia induction. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of ΔPI for PIH, including calculation of the area under the curve (AUC), optimal cut-off value, sensitivity, and specificity. Data from 96 patients were analyzed. After anesthesia induction, 51 patients (53.1%) developed PIH. The AUC of ΔPI for predicting PIH was 0.824 (95% CI: 0.741–0.908). The optimal cut-off value of ΔPI was 22.0%, which yielded a sensitivity of 72.5% and a specificity of 86.7%. This study was registered in the Clinical Trial Registry of China on 17/12/2024 (ChiCTR2400094135). The ΔPI between supine and 45° semi-recumbent positions was a reliable predictor of post-induction hypotension after general anesthesia induction, wherein ΔPI greater than 22.0% was the threshold.
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Li et al. (2026) conducted an observational in Post-induction hypotension (PIH) during general anesthesia (n=96). Change in perfusion index (∆PI) between supine and 45° semi-recumbent positions vs. Static baseline perfusion index was evaluated on Post-induction hypotension (SBP < 90 mmHg, MAP < 65 mmHg, or MAP reduction > 30% from baseline) (OR 1.126, 95% CI 1.036-1.224, p=0.005). The change in perfusion index between supine and 45° semi-recumbent positions predicted post-induction hypotension with an AUC of 0.824, where a change greater than 22.0% yielded 72.5% sensitivity.
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