Anaesthetic techniques, i.v.; monitoring, depth of anaesthesia; pain, acute
Abstract :
[en] BACKGROUND: The Surgical Pleth Index (SPI) is proposed as a means to assess the balance between noxious stimulation and the anti-nociceptive effects of anaesthesia. In this study, we compared SPI, mean arterial pressure (MAP), and heart rate (HR) as a means of assessing this balance. METHODS: We studied a standard stimulus [head-holder insertion (HHI)] and varying remifentanil concentrations (CeREMI) in a group of patients undergoing neurosurgery. Patients receiving target-controlled infusions were randomly assigned to one of the three CeREMI (2, 4, or 6 ng m(1)), whereas propofol target was fixed at 3 microg ml(1). Steady state for both targets was achieved before HHI. Intravascular volume status (IVS) was evaluated using respiratory variations in arterial pressure. Prediction probability (Pk) and ordinal regression were used to assess SPI, MAP, and HR performance at indicating CeREMI, and the influence of IVS and chronic treatment for high arterial pressure, as possible confounding factors. RESULTS: The maximum SPI, MAP, or HR observed after HHI correctly indicated CeREMI in one of the two patients [accurate prediction rate (APR)=0.5]. When IVS and chronic treatment for high arterial pressure were taken into account, the APR was 0.6 for each individual variable and 0.8 when all of them predicted the same CeREMI. That increase in APR paralleled an increase in Pk from 0.63 to 0.89. CONCLUSIONS: SPI, HR, and MAP are of comparable value at gauging noxious stimulation-CeREMI balance. Their interpretation is improved by taking account of IVS, treatment for chronic high arterial pressure, and concordance between their predictions.
Disciplines :
Anesthesia & intensive care Neurology
Author, co-author :
Bonhomme, Vincent ; Centre Hospitalier Universitaire de Liège - CHU > Anesthésie et réanimation
Uutela, K.
Hans, Grégory ; Centre Hospitalier Universitaire de Liège - CHU > Anesthésie et réanimation
Maquoi, Isabelle ; Centre Hospitalier Universitaire de Liège - CHU > Soins intensifs
Born, J. D.
Brichant, Jean-François ; Université de Liège - ULiège > Département des sciences cliniques > Anesthésie et réanimation
Lamy, Maurice ; Centre Hospitalier Universitaire de Liège - CHU > Anesthésie et réanimation
Hans, Pol ; Centre Hospitalier Universitaire de Liège - CHU > Anesthésie et réanimation
Language :
English
Title :
Comparison of the Surgical Pleth Index (TM) with haemodynamic variables to assess nociception-anti-nociception balance during general anaesthesia
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