Stimulation induced variability of pulse plethysmography does not discriminate responsiveness to intubation

Luginbühl, M; Rüfenacht, M; Korhonen, I; Gils, M; Jakob, S; Petersen-Felix, S. (2006). Stimulation induced variability of pulse plethysmography does not discriminate responsiveness to intubation. British journal of anaesthesia, 96(3), pp. 323-329. Oxford: Oxford University Press 10.1093/bja/aei315

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BACKGROUND: Hypnotic depth but not haemodynamic response to painful stimulation can be measured with various EEG-based anaesthesia monitors. We evaluated the variation of pulse plethysmography amplitude induced by an electrical tetanic stimulus (PPG variation) as a potential measure for analgesia and predictor of haemodynamic responsiveness during general anaesthesia. METHODS: Ninety-five patients, ASA I or II, were randomly assigned to five groups [Group 1: bispectral index (BIS) (range) 40-50, effect site remifentanil concentration 1 ng ml(-1);Group 2: BIS 40-50, remifentanil 2 ng ml(-1); Group 3: BIS 40-50, remifentanil 4 ng ml(-1); Group 4: BIS 25-35, remifentanil 2 ng ml(-1); Group 5: BIS 55-65, remifentanil 2 ng ml(-1)]. A 60 mA tetanic stimulus was applied for 5 s on the ulnar nerve. From the digitized pulse oximeter wave recorded on a laptop computer, linear and non-linear parameters of PPG variation during the 60 s period after stimulation were computed. The haemodynamic response to subsequent orotracheal intubation was recorded. The PPG variation was compared between groups and between responders and non-responders to intubation (anova). Variables independently predicting the response were determined by logistic regression. RESULTS: The probability of a response to tracheal intubation was 0.77, 0.47, 0.05, 0.18 and 0.52 in Groups 1-5, respectively (P<0.03). The PPG variability was significantly higher in responders than in non-responders but it did not improve the prediction of the response to tracheal intubation based on BIS level and effect site remifentanil concentration. CONCLUSION: Tetanic stimulation induced PPG variation does not reflect the analgesic state in a wide clinical range of surgical anaesthesia.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care

UniBE Contributor:

Luginbühl, Martin; Jakob, Stephan and Petersen, Steen

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0007-0912

ISBN:

16415316

Publisher:

Oxford University Press

Language:

English

Submitter:

Jeannie Wurz

Date Deposited:

04 Oct 2013 14:46

Last Modified:

02 Oct 2018 14:19

Publisher DOI:

10.1093/bja/aei315

PubMed ID:

16415316

Web of Science ID:

000235434500006

BORIS DOI:

10.7892/boris.19150

URI:

https://boris.unibe.ch/id/eprint/19150 (FactScience: 1545)

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