Correlation of Surgical Pleth Index with Stress Hormones during Propofol-Remifentanil Anaesthesia

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

doi:10.1100/2012/879158

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.

Highlights

Excessive intraoperative stress evoked by surgical nociceptive stimulation may influence patients’ outcome, length of hospital stay, and overall costs of hospital care [1, 2]
Single-blinded, randomized study, we investigated the relationship between surgical pleth index (SPI) values, BIS values, arterial blood pressure (ABP), heart rate (HR) and stress hormones’ values (ACTH, cortisol, epinephrine, and norepinephrine) at four event-related time points during propofol-remifentanil anaesthesia in patients undergoing ear-nose-throat (ENT) surgery
We investigated the correlation between the surgical pleth index (SPI), a noninvasive variable derived from photoplethysmography which was developed originally for detecting stress or nociception level during general anaesthesia, with stress hormones in the circulating blood in a prospective, single-blinded, randomized study, and demonstrated that (1) SPI had no correlation with stress hormones at the time-point Base, whereas there was moderate-togood correlation with the stress hormones at the time-points Intu, Max, and After-Max (15 min after the maximum surgical trauma); (2) SPI could predict a specific level of adrenocorticotropic hormone (ACTH) with high sensitivity and specificity

Summary

Introduction

Excessive intraoperative stress evoked by surgical nociceptive stimulation may influence patients’ outcome, length of hospital stay, and overall costs of hospital care [1, 2]. To achieve adequate analgesia (antinociception) blunting the intraoperative stress response, most notably haemodynamic instability, it is crucial to use an ideal variable for assessing the stress level or, perhaps more accurately, the balance of nociception-antinociception [3], during general anaesthesia. Such an ideal (continuous, noninvasive, accurate) variable, which may be used for guiding administration of analgesics to attenuate the stress response, is still missing. Given the results from the above studies, the SPI seems like a relatively ideal variable for measurement of intraoperative stress or nociception

Methods

Results

Conclusion