The Perfusion Index of the Ear as a Predictor of Hypotension Following the Induction of Anesthesia in Patients with Hypertension: A Prospective Observational Study

Patients with hypertension develop hemodynamic instability more frequently during anesthesia—particularly post-induction. Therefore, different monitoring methods may be required in patients with hypertension. Perfusion index—the ratio of the pulsatile blood flow to the non-pulsatile static blood flow in a patient’s peripheral tissues, such as the fingers or ears—can show the hemodynamic status of the patient in a non-invasive way. Among the sites used for measuring the perfusion index, it is assumed that the ear is more reliable than the finger for hemodynamic monitoring, because proximity to the brain ensures appropriate perfusion. We hypothesized that the low value of preoperative ear PI could be a predictor of post-induction hypotension in patients with hypertension. Thirty patients with hypertension were enrolled. The perfusion index and pleth variability index were measured using the ear, finger, and blood pressure, and heart rate was recorded to monitor hypotension. After insertion of the supraglottic airway, 20 patients developed post-induction hypotension. Those who developed hypotension showed a significantly lower preoperative perfusion index of the ear. The preoperative perfusion index of the ear could predict post-induction hypotension in patients with hypertension.