Predictive value of the surgical pleth index for the hemodynamic responses to trachea intubation and skin incision
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ORIGINAL RESEARCH
Predictive value of the surgical pleth index for the hemodynamic responses to trachea intubation and skin incision Meng Wang1 · Xiao Wang1 · Rui Bao1 · Wen‑zhong Zhu1 · Jin‑jun Bian1 · Xiao‑ming Deng1 · Wen‑jun Han1 · Jia‑feng Wang1 Received: 13 August 2019 / Accepted: 17 November 2019 © Springer Nature B.V. 2019
Abstract Surgical pleth index (SPI) has been widely investigated in assessing the nociceptive level. The aim of this study was to investigate the relationship between SPI level and patient responses to trachea intubation and skin incision. A total of 40 patients undergoing open abdominal general surgery were recruited for analyses. The patients were monitored with electrocardiogram, non-invasive blood pressure, S pO2, invasive blood pressure and SPI before anesthesia induction. Anesthesia was induced with midazolam, propofol, sufentanil and rocuronium and maintained with sufentanil and sevoflurane. Blood pressure, heart rate and SPI were recorded for analyses during the peri-intubation and peri-incision periods. A receiver operating characteristic (ROC) curve analysis was performed to analyze the predictive value of blood pressure, heart rate (HR) and SPI for hemodynamic responses for trachea intubation and skin incision. SPI had a similar changing trend to systolic blood pressure (SBP) and diastolic blood pressure (DBP). The SPI level was linearly correlated with SBP, DBP and HR. SPI increased significantly after intubation and incision in patients with positive but not negative responses to intubation and incision. The ROC analysis showed that only SBP level is predictive of intubation responses. These data suggested that SPI elevated under the noxious stimulation by intubation and incision, but it was not predictive of the hemodynamic responses to intubation and incision. Keywords Surgical pleth index · Nociception · Sympathetic response · Hemodynamic reaction
1 Introduction Pain is a subjective feeling which is hard to quantify, thus visual analogue scale (VAS) has been widely used to assess pain in conscious people [1]. But it is not feasible to use this scale during general anesthesia when the patients cannot respond to the noxious stimuli. Currently, most of the anesthesiologists administer the analgesics based on the pharmacokinetic models of the drugs or the hemodynamic changes during surgery. But the pharmacokinetic model may not reflect the actual pharmacological status, and the Meng Wang and Xiao Wang have contributed equally to this work. * Wen‑jun Han [email protected] * Jia‑feng Wang [email protected] 1
Faculty of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, China
hemodynamic changes may be affected by the comorbidities of the patients. Therefore, multiple techniques and devices have been developed to monitor the nociception, such as surgical pleth index (SPI) [2], nociception level [3], analgesia nociception index (ANI) [4], pupillometry [4], nasal photoplethysmography [5] and so on. SPI, previously named surgical stress index, is des
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