Correlation of surgical pleth index with stress hormones during propofol-remifentanil anaesthesia

Xinzhong Chen, Carsten Thee, Matthias Gruenewald, Christoph Ilies, Jan Höcker, Robert Hanss, Markus Steinfath, Berthold Bein, Xinzhong Chen, Carsten Thee, Matthias Gruenewald, Christoph Ilies, Jan Höcker, Robert Hanss, Markus Steinfath, Berthold Bein

Abstract

Eighty patients undergoing elective ear-nose-throat surgery were enrolled in the present study to investigate the relationship between surgical pleth index (SPI) and stress hormones (ACTH, cortisol, epinephrine, norepinephrine) during general anaesthesia which was induced and maintained with propofol and remifentanil using a target-controlled infusion. The study concluded that the SPI had moderate correlation to the stress hormones during general anaesthesia, but no correlation during consciousness. Furthermore, SPI values were able to predict ACTH values with high sensitivity and specificity.

Figures

Figure 1
Figure 1
Values are mean ± SD. Base: baseline before anaesthesia; Intu: after tracheal intubation; Max: at maximum operative trauma which was defined intraoperatively by the surgeon; After-Max: 15 min after the maximum operative trauma; Mean: mean blood pressure; HR: heart rate; SPI: the group in which remifentanil administration was guided by SPI; Control: the group in which remifentanil administration was guided by standard traditional inadequate anaesthesia criteria. *P < 0.05, **P < 0.01 compared with respective values at Base in the same group with one-way ANOVA followed by LSD test. #P < 0.05, ##P < 0.01 compared with respective values at Intu in the same group with one-way ANOVA followed by LSD test. &P < 0.05, &&P < 0.01 compared with respective values at Maxi in the same group with one-way ANOVA followed by LSD test. No differences were found between the SPI group and the Control group at all four event-related time points (P > 0.05).
Figure 2
Figure 2
Linear regression analysis and correlation analysis between the SSI values and and stress hormones (ACTH, cortisol, epinephrine and norepinephrine). Bold line is regression line. Slopes of the above lines between time points are significantly different, P < 0.01. ACTH: adrenocorticotropic hormone; SPI: surgical pleth index; Base: baseline before anaesthesia; Intu: after tracheal intubation; Max: at maximum operative trauma, defined intraoperatively by the surgeon; After-Max: 15 min after the maximum operative trauma.

References

    1. Parker SD, Breslow MJ, Frank SM, et al. Catecholamine and cortisol responses to lower extremity revascularization: correlation with outcome variables. Critical Care Medicine. 1995;23(12):1954–1961.
    1. Myles PS, Hunt JO, Fletcher H, et al. Remifentanil, fentanyl, and cardiac surgery: a double-blinded, randomized, controlled trial of costs and outcomes. Anesthesia and Analgesia. 2002;95(4):805–812.
    1. Struys MMRF, Vanpeteghem C, Huiku M, Uutela K, Blyaert NBK, Mortier EP. Changes in a surgical stress index in response to standardized pain stimuli during propofol-remifentanil infusion. British Journal of Anaesthesia. 2007;99(3):359–367.
    1. Buhre W, Rossaint R. Perioperative management and monitoring in anaesthesia. Lancet. 2003;362(9398):1839–1846.
    1. Bruhn J, Myles PS, Sneyd R, Struys MMRF. Depth of anaesthesia monitoring: what’s available, what’s validated and what’s next? British Journal of Anaesthesia. 2006;97(1):85–94.
    1. Heier T, Steen PA. Assessment of anaesthesia depth. Acta Anaesthesiologica Scandinavica. 1996;40(9):1087–1100.
    1. Rantanen M, Yli-Hankala A, van Gils M, et al. Novel multiparameter approach for measurement of nociception at skin incision during general anaesthesia. British Journal of Anaesthesia. 2006;96(3):367–376.
    1. Huiku M, Uutela K, van Gils M, et al. Assessment of surgical stress during general anaesthesia. British Journal of Anaesthesia. 2007;98(4):447–455.
    1. Wennervirta J, Hynynen M, Koivusalo AM, Uutela K, Huiku M, Vakkuri A. Surgical stress index as a measure of nociception/antinociception balance during general anesthesia. Acta Anaesthesiologica Scandinavica. 2008;52(8):1038–1045.
    1. Gruenewald M, Meybohm P, Ilies C, et al. Influence of different remifentanil concentrations on the performance of the surgical stress index to detect a standardized painful stimulus during sevoflurane anaesthesia. British Journal of Anaesthesia. 2009;103(4):586–593.
    1. Smith WD, Dutton RC, Smith NT. Measuring the performance of anesthetic depth indicators. Anesthesiology. 1996;84(1):38–51.
    1. Smith WD, Dutton RC, Smith NT. A measure of association for assessing prediction accuracy that is a generalization of non-parametric roc area. Statistics in Medicine. 1996;15:1199–1215.
    1. Chen X, Thee C, Gruenewald M, et al. Comparison of surgical stress index-guided analgesia with standard clinical practice during routine general anesthesia: a pilot study. Anesthesiology. 2010;112(5):1175–1183.
    1. Schricker T, Carli F, Schreiber M, et al. Propofol/sufentanil anesthesia suppresses the metabolic and endocrine response during, not after, lower abdominal surgery. Anesthesia and Analgesia. 2000;90(2):450–455.
    1. Roizen MF, Horrigan RW, Frazer BM. Anesthetic doses blocking adrenergic (stress) and cardiovascular responses to incision-MAC BAR. Anesthesiology. 1981;54(5):390–398.
    1. Ledowski T, Bein B, Hanss R, et al. Neuroendocrine stress response and heart rate variability: a comparison of total intravenous versus balanced anesthesia. Anesthesia and Analgesia. 2005;101(6):1700–1705.
    1. Gruenewald M, Zhou J, Schloemerkemper N, et al. M-Entropy guidance vs standard practice during propofol-remifentanil anaesthesia: a randomised controlled trial. Anaesthesia. 2007;62(12):1224–1229.
    1. Kreuer S, Biedler A, Larsen R, Altmann S, Wilhelm W. Narcotrend monitoring allows faster emergence and a reduction of drug consumption in propofol-remifentanil anesthesia. Anesthesiology. 2003;99(1):34–41.
    1. Garrioch MA, Fitch W. Anaesthesia for carotid artery surgery. British Journal of Anaesthesia. 1993;71(4):569–579.
    1. Schnider TW, Minto CF, Gambus PL, et al. The influence of method of administration and covariates on the pharmacokinetics of propofol in adult volunteers. Anesthesiology. 1998;88(5):1170–1182.
    1. Minto CF, Schnider TW, Shafer SL. Pharmacokinetics and pharmacodynamics of remifentanil II. Model application. Anesthesiology. 1997;86(1):21–33.
    1. Mustola S, Parkkari T, Uutela K, Huiku M, Kymäläinen M, Toivonen J. Performance of surgical stress index during sevoflurane-fentanyl and isoflurane-fentanyl anesthesia. Anesthesiology Research and Practice. 2010;2010:5 pages.810721
    1. Zbinden AM, Maggiorini M, Petersen-Felix S, et al. Anesthetic depth defined using multiple noxious stimuli during isoflurane/oxygen anesthesia: I. Motor reactions. Anesthesiology. 1994;80(2):253–260.
    1. Sandin RH, Enlund G, Samuelsson P, Lennmarken C. Awareness during anaesthesia: a prospective case study. Lancet. 2000;355(9205):707–711.
    1. Bein B. Entropy. Best Practice & Research Clinical Anaesthesiology . 2006;20:101–109.
    1. Takamatsu I, Ozaki M, Kazama T. Entropy indices vs the bispectral index for estimating nociception during sevoflurane anaesthesia. British Journal of Anaesthesia. 2006;96(5):620–626.
    1. Storm H, Myre K, Rostrup M, Stokland O, Lien MD, Ræder JC. Skin conductance correlates with perioperative stress. Acta Anaesthesiologica Scandinavica. 2002;46(7):887–895.
    1. Seitsonen ERJ, Korhonen IKJ, Van Gils MJ, et al. EEG spectral entropy, heart rate, photoplethysmography and motor responses to skin incision during sevoflurane anaesthesia. Acta Anaesthesiologica Scandinavica. 2005;49(3):284–292.
    1. Guignard B. Monitoring analgesia. Best Practice and Research: Clinical Anaesthesiology. 2006;20(1):161–180.
    1. Nishiyama T. Recent advance in patient monitoring. Korean Journal of Anesthesiology. 2010;59(3):144–159.
    1. Ahonen J, Jokela R, Uutela K, Huiku M. Surgical stress index reflects surgical stress in gynaecological laparoscopic day-case surgery. British Journal of Anaesthesia. 2007;98(4):456–461.
    1. Desborough J. Endocrine response to surgery. In: Kaufman L, editor. Anaesthesia Review. Edinburgh, UK: Churchill Livingstone; 1993. pp. 131–148.
    1. Desborough JP. The stress response to trauma and surgery. British Journal of Anaesthesia. 2000;85(1):109–117.
    1. Crofford LJ, Young EA, Engleberg NC, et al. Basal circadian and pulsatile ACTH and cortisol secretion in patients with fibromyalgia and/or chronic fatigue syndrome. Brain, Behavior, and Immunity. 2004;18(4):314–325.
    1. Haddad JJ, Saadé NE, Safieh-Garabedian B. Cytokines and neuro-immune-endocrine interactions: a role for the hypothalamic-pituitary-adrenal revolving axis. Journal of Neuroimmunology. 2002;133(1-2):1–19.
    1. Nishiyama T, Yamashita K, Yokoyama T. Stress hormone changes in general anesthesia of long duration: isoflurane-nitrous oxide vs sevoflurane-nitrous oxide anesthesia. Journal of Clinical Anesthesia. 2005;17(8):586–591.
    1. Traynor C, Hall GM. Endocrine and metabolic changes during surgery: anaesthetic implications. British Journal of Anaesthesia. 1981;53(2):153–160.
    1. Halter JB, Pflug AE, Porte D. Mechanism of plasma catecholamine increases during surgical stress in man. Journal of Clinical Endocrinology and Metabolism. 1977;45(5):936–944.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren