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Postoperative pain in children is usually undertreated because of their inability to complain. While several pain assessment scales have been developed, they have shortcomings such as subjectivity and being observer-dependent. This study aimed to assess the validity of the perfusion index as an objective measure of postoperative pain in children undergoing adenotonsillectomy. Children aged 3-7 years were enrolled. The Children's Hospital of Eastern Ontario Scale (CHEOPS) was used to assess postoperative pain. The perfusion index was measured at the same time intervals as CHEOPS. The highest CHEOPS before rescue analgesia was administered and CHEOPS when the patients became pain-free were recorded with the corresponding perfusion index. The primary outcome was the correlation between the postoperative CHEOPS and the corresponding postoperative perfusion index. The secondary outcomes were the ability of perfusion index changes to predict the presence of postoperative pain and patients' response to analgesics. The postoperative perfusion index was negatively correlated with CHEOPS at 30 and 90 min postoperatively. The change in the preoperative baseline perfusion index (ΔPI-pre) was moderately correlated with the highest CHEOPS (CHEOPS-1) (r = 0.61, p = 0.001). The change in the postoperative perfusion index (ΔPI-po) was negatively correlated with the change in the CHEOPS (ΔCHEOPS) (r = - 0.53, P = 0.0001). The ΔPI-pre was an excellent predictor of postoperative pain (AUROC 0.83 with 71% sensitivity, 83% specificity, and a cut-off value of ≥ 0.26). The perfusion index is a good objective measure for predicting the presence of postoperative pain in children undergoing adenotonsillectomy under general anesthesia. Trial registration: ClinicalTrials.gov; ID: (NCT03854604) registered on February 2019., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

Background: Induction of general anaesthesia is commonly associated with hypotension. This exposes patients to perioperative organ hypoperfusion and eventually damage. This study was designed to assess the ability of preoperative perfusion index (PI), plethysmographic variability index (PVI), and dicrotic plethysmography (Dicpleth) to predict hypotension after induction of general anaesthesia., Methods: In this cohort study, 95 ASA I and II adult patients who were scheduled for elective surgery under general anaesthesia were enrolled. The correlation between preoperative PI, PVI, Dicpleth and percentage decrease in mean arterial blood pressure after anaesthesia induction was investigated. Ability of PI, PVI, Dicpleth to detect post-induction hypotension was also analysed., Results: The percent decrease in MAP after anaesthesia correlated with baseline PI (r = -0.45, P < 0.001), PVI (r = 0.45, P = 0.001) and Dicpleth (r = 0.16, P = 0.12). The PI cut-off value was ≤ 3.03 for a patient at risk for post-induction hypotension with 77.8% sensitivity, 75% specificity, positive and negative predictive values of 74.5% and 78.3%, respectively. Similarly, the ROC analysis revealed that baseline PVI (AUC = 0.73, 95% CI = 0.622-0.812) was suitable for detecting post-induction hypotension. Moreover, baseline Dicpleth (AUC = 0.63) showed significant predictive ability., Conclusions: The pre-anaesthetic PI and PVI 17, respectively, have a good ability to predict those at risk of developing post-induction hypotension in adult patients undergoing elective surgery under general anaesthesia. Future studies are needed in order to investigate the usefulness of Dicpleth in different circumstances during anaesthesia. Clinical trial registration ID: The study was registered at clinicaltrials.gov (NCT04217226).