Document Detail


Comparison of the surgical Pleth Index™ with haemodynamic variables to assess nociception-anti-nociception balance during general anaesthesia.
MedLine Citation:
PMID:  21051493     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 µg 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.
Authors:
V Bonhomme; K Uutela; G Hans; I Maquoi; J D Born; J F Brichant; M Lamy; P Hans
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2010-11-04
Journal Detail:
Title:  British journal of anaesthesia     Volume:  106     ISSN:  1471-6771     ISO Abbreviation:  Br J Anaesth     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2010-12-14     Completed Date:  2011-01-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372541     Medline TA:  Br J Anaesth     Country:  England    
Other Details:
Languages:  eng     Pagination:  101-11     Citation Subset:  IM    
Affiliation:
Department of Anaesthesia and Intensive Care Medicine, CHU Liege, Liege, Belgium. vincent.bonhomme@chu.ulg.ac.be
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Anesthesia, General / methods*
Anesthetics, Intravenous / pharmacology
Blood Pressure / drug effects
Female
Heart Rate / drug effects
Hemodynamics / drug effects*
Humans
Male
Middle Aged
Monitoring, Intraoperative / methods*
Neurosurgical Procedures
Pain / diagnosis*
Pain Measurement / methods
Piperidines / pharmacology
Propofol / pharmacology
Young Adult
Chemical
Reg. No./Substance:
0/Anesthetics, Intravenous; 0/Piperidines; 132875-61-7/remifentanil; 2078-54-8/Propofol

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