title: Using a pulse oximeter to determine clinical depth of anesthesia-investigation of the utility of the perfusion index.
abstract: BACKGROUND
  Peripheral vasodilation is a well-recognized side effect of general anesthesia, and induces changes in the amplitude of the pulse plethysmograph (PPG) waveform. This can be continuously quantitaed using the Perfusion Index (PI), a ratio of the pulsatile to nonpulsatile signal amplitude in the PPG waveform. We hypothesized that the perfusion index would rise with the induction of anesthesia in children, and fall with emergence, and performed a prospective, observational study to test this.
  
  
  OBJECTIVE
  Our primary aim was to test whether the different clinical stages of anesthesia were associated with changes in the perfusion index, and the secondary aim was to test the correlation between the normalized perfusion index and the MAC value.
  
  
  METHODS
  Twenty-one patients between the ages of 1 and 18 undergoing minor procedures with no anticipated painful stimuli were recruited. Patients with significant illnesses were excluded. Data collection commenced with a preinduction baseline, and data were collected continuously, with event marking, until completion of the anesthesia and removal of the pulse oximeter. Data collected included perfusion index, heart rate, and anesthetic gas concentration values. A normalized perfusion index was calculated by subtracting the initial baseline perfusion index value from all perfusion index values, allowing changes, from a standardized initial baseline value of zero, to be analyzed.
  
  
  RESULTS
  During induction, the mean normalized perfusion index rose from 0.0 to 4.2, and then declined to 0.470 when the patients returned to consciousness. P < 0.001 using repeated measures anova test. The normalized perfusion index was correlated with MAC values (r2= 0.33, 95% CI 0.18-0.47, P < 0.01).
  
  
  CONCLUSIONS
  The perfusion index changed significantly during different stages of anesthesia. There is a significant correlation between the perfusion index, measured by pulse oximetry, and the MAC value, in pediatric patients undergoing minor procedures.
authors: Department of Anaesthesia, The Children's Hospital at Westmead, Sydney Children's Hospital Network, Sydney, NSW, Australia.
authors: Anirudh
authors: A
authors: Krishnamohan
authors: Department of Anaesthesia, The Children's Hospital at Westmead, Sydney Children's Hospital Network, Sydney, NSW, Australia.
authors: Viraj
authors: V
authors: Siriwardana
authors: Department of Anaesthesia, The Children's Hospital at Westmead, Sydney Children's Hospital Network, Sydney, NSW, Australia. Justin.skowno@health.nsw.gov.au.|Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia. Justin.skowno@health.nsw.gov.au.
authors: Justin J
authors: http://orcid.org/0000-0002-4398-2150
authors: JJ
authors: Skowno
mesh_terms: D000293:Adolescent; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General; D001794:Blood Pressure / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D056805:Consciousness Monitors; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007223:Infant; D008297:Male; D016343:Monitoring, Intraoperative / Q000295:instrumentation*; D010092:Oximetry / Q000295:instrumentation*; D010991:Plethysmography / Q000295:instrumentation; D011446:Prospective Studies
keywords: children; intraoperative monitoring; perfusion index; plethysmography; pulse oximeter; vasodilation