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Background: To reduce the dosages of the intraoperative anaesthetic and analgesic agents, the caudal block is most frequently used in children. The work aims to investigate the efficacy of perfusion index (PI) and heart rate (HR) variations following the caudal block in determining the onset and appropriateness of the caudal block in children. Patients and methods: After induction of general anaesthesia, 0.5–1 ml/kg of 0.25% bupivacaine according to the needed block level using a 22-gauge needle. Bupivacaine dose was given as an initial injection of 0.2 ml/kg for 3–4 s; the remaining dose was given at the same flow after 1 min. The lowest HRs were observed during and up to 1 min after the initial injection, as well as during and up to 1 min after the complete drug delivery. Prior to and every 2 min following the caudal block, the PI of all children was measured. Results: There was a significant difference between the caudal success group and the caudal failure group regarding median PI (p < 0.001). At the initial and total caudal bupivacaine doses, there was a significant fall between the median HR caudal success group and the median HR caudal failure group (p < 0.001). Conclusion: A decrease in HR of −2 and −3 beats/minute during or shortly after an initial and entire caudal drug injection, respectively, and median PI are reliable methods in the prediction of caudal success. [ABSTRACT FROM AUTHOR]

Background: The most common drawback of spinal anesthesia (SA) is hypotension, which has adverse effects on both mother and fetus; consequently, early detection and management of spinal hypotension have been considered a very important topic in obstetric anesthesia. Additionally, the capability to ultimately diagnose hypotension could permit initiation of adequate treatment. The standard method to estimate blood pressure during cesarean section is noninvasive blood pressure measurement. However, periods of hypotension could be missed within a reasonable time frame. Methods: Perfusion index (PI) and blood pressure were measured in 100 pregnant women during elective cesarean section under SA. Results: PI had a significant negative correlation with the change occurred in systolic blood pressure (SBP) (r = -.432, p < .0001); by using univariate linear regression analysis, the PI explains 20.2% of variability in SBP as PI significantly predicts the change occurred in SBP (F = 24.8, p < .0001), as each one unit increase in PI, accompanied by a significant decrease in SBP by 2.089 (mm/hg), as (b, t, p) (-2.089, -4.987, .0001), respectively. There was a significant difference in SBP and PI before and after giving oxytocin bolus [(z = -1.9, P = .05) and (z = -4.3, P < .0001), respectively]. By comparing PI before vs. after taking ephedrine bolus, there was a significant decrease in median of PI [median of PI before 10 (5.5-15) vs. median of PI after 7.5 (6-15.5) (z = -6.6, P < .0001)]. Discussion: After SA with sympathetic blockade, peripheral vascular tone declined and therefore PI increased. Conclusion: PI could anticipate the incidence of hypotension during cesarean delivery with SA. Ephedrine effect could be evaluated rapidly by the alteration in the PI so that further need can be judged. Oxytocin has a significant impact on vascular tone with 5 international unit bolus, although it does not have a significant effect on blood pressure. [ABSTRACT FROM AUTHOR]