A beat-by-beat cardiovascular index, CARDEAN, to titrate opioid administration in the setting of orthopaedic surgery: a
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ORIGINAL RESEARCH
A beat‑by‑beat cardiovascular index, CARDEAN, to titrate opioid administration in the setting of orthopaedic surgery: a prospective randomized trial Pierre‑François Wey1 · Damien Loheas1 · Antoine Lamblin1 · Benjamin Riche2 · Muriel Rabilloud2 · Jacques Escarment1 · Marc Puidupin1 · Luc Quintin1,3 · Jean‑Yves Martinez1 · Andrei Cividjian1,3,4 Received: 10 September 2019 / Accepted: 21 September 2020 © Springer Nature B.V. 2020
Abstract To determine whether a beat-by-beat cardiovascular index (CARDEAN: cardiovascular depth of analgesia, Alpha-2 Ltd, Lyon, France) reduces the incidence of tachycardia in ASA I–III patients undergoing orthopaedic surgery. A total of 76 patients were prospectively randomized into (1) a control group or (2) the CARDEAN group, in which the nurse anaesthetist was blinded to CARDEAN application. In addition to conventional signs, an external observer instructed the nurse anaesthetist to administer sufentanil 0.1 µg kg−1 when the CARDEAN crossed a threshold (≥ 60). The primary outcome was the incidence of tachycardia (> 120% of reference heart rate, HR). Non-invasive blood pressure (BP), electrocardiogram (ECG), O2 saturation-photoplethysmography and the bispectral index (40 140/90 mmHg), treated heart failure (New York Heart Association class I or II), coronary artery disease, diabetes, thyroid disease, treated epilepsy, vertigo, or syncope were included. Patients with non-sinus rhythm (e.g., atrio-ventricular block, atrial fibrillation) or those taking cardiovascular drugs (β-blockers, α2-agonists/imidazolines, Ca channel blockers, digitalis, amiodarone), incapacitated adults, patients without social security coverage, pregnant or lactating women, and patients with stroke or psychiatric or senile/vascular pathology were excluded. No patient included in a previous study [7, 11, 15, 16] was enrolled in the present study.
2.2 Anaesthesia Sixty minutes before surgery, patients received 10 µg kg−1 alprazolam orally. Throughout the operating room (OR) stay, patients were actively warmed (warm draping followed by a Bair Hugger, Arizant, Eden Prairie, MN). Patients were monitored (Xprezzon, Spacelabs, Issaquah, WA) as follows: (a) an electrocardiogram (ECG); (b) pulse oximetry ( SpO2); (c) non-invasive oscillometric blood pressure (NIBP) every min up to the time of intubation and every 3 min after intubation until transfer to the post-anaesthesia care unit (PACU); (d) the Bispectral index (BIS XP4.0, Aspect, Newton, MA; reset every 30 s); and (e) CARDEAN™ 4.0 (Alpha-2, Lyon, France). The CARDEAN index [7, 11] was computed on-line by a PC using data from the ECG and PPG signals acquired from a Philips IntelliVue MP5 monitor, in parallel with the Spacelabs monitor (Fig. 1a, ESM). The observer (AC) responsible for data collection, who was not involved in anaesthesia management, was the only individual that
Journal of Clinical Monitoring and Computing
Fig. 1 CONSORT flow chart for enrolment, allocation, and exclusion
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could access the CARDEAN display; the nurse ana
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