Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig Holstein Campus Kiel, Schwanenweg 21, D-24105 Kiel, Germany.
Br J Anaesth. 2014 May;112(5):898-905. doi: 10.1093/bja/aet485. Epub 2014 Feb 16.
Evaluation of analgesia and antinociception during anaesthesia is still a challenging issue and routinely based on indirect and non-specific signs such as movement, tachycardia, or lacrimation. Recently, the surgical pleth index (SPI) derived by finger plethysmography was introduced to detect nociceptive stimulation during anaesthesia. While SPI guidance reduced the number of unwanted events during total i.v. anaesthesia (TIVA), the impact of SPI during volatile-based anaesthesia with intermittent opioid administration has not yet been elucidated.
Ninety-four patients were randomized into either SPI-guided analgesia or standard practice (Control). In both groups, anaesthesia was maintained with sevoflurane to keep bispectral index values between 40 and 60. In the SPI group, patients received a sufentanil bolus (10 μg) whenever SPI value increased above 50, whereas in the control group, sufentanil was administered according to standard clinical practice. The number of unwanted somatic events, haemodynamics, sufentanil consumption, and recovery times were recorded.
The incidence of intraoperative unwanted somatic events was comparable between the groups (P=0.89). No significant differences with respect to hypotensive or hypertensive events were found. The mean (95% confidence interval) sufentanil consumption was non-significantly (P=0.07) reduced in the SPI group, 0.64 (0.57-0.71) vs 0.78 (0.64-0.91) µg min(-1). Recovery times were comparable between the groups.
Sufentanil administration guided by SPI during sevoflurane anaesthesia is clinically feasible. In contrast to TIVA, it did not improve anaesthesia conduct with respect to unwanted somatic events, haemodynamic stability, sufentanil consumption, emergence time, or post-anaesthesia care unit care. Therefore, we conclude that anaesthesia regimen has an impact on beneficial effects by SPI guidance. Clinical trial registration NCT01525537. (Registered at Clinicaltrials.gov.).
麻醉期间的镇痛和抗伤害感受评估仍然是一个具有挑战性的问题，通常基于间接的、非特异性的迹象，如运动、心动过速或流泪。最近，通过手指体积描记法得出的手术 pleth 指数（SPI）被引入以检测麻醉期间的伤害性刺激。虽然 SPI 指导减少了全静脉麻醉（TIVA）期间不必要事件的发生，但 SPI 对间歇性给予阿片类药物的挥发性麻醉的影响尚未阐明。
94 名患者被随机分为 SPI 指导的镇痛组或标准治疗组（对照组）。在两组中，均以七氟醚维持麻醉，使脑电双频指数值在 40 至 60 之间。在 SPI 组中，每当 SPI 值升高超过 50 时，给予患者舒芬太尼推注（10 μg），而在对照组中，根据标准临床实践给予舒芬太尼。记录术中不必要的躯体事件、血流动力学、舒芬太尼消耗和恢复时间。
两组术中不必要的躯体事件发生率相当（P=0.89）。未发现低血压或高血压事件的显著差异。舒芬太尼消耗的平均值（95%置信区间）在 SPI 组中无显著差异（P=0.07），为 0.64（0.57-0.71）μg min(-1) vs 0.78（0.64-0.91）μg min(-1)。两组的恢复时间相当。
七氟醚麻醉期间舒芬太尼的 SPI 指导在临床上是可行的。与 TIVA 不同，它在不必要的躯体事件、血流动力学稳定性、舒芬太尼消耗、苏醒时间或麻醉后护理单元护理方面并没有改善麻醉效果。因此，我们得出结论，麻醉方案对 SPI 指导的有益效果有影响。临床试验注册号 NCT01525537。（在 Clinicaltrials.gov 注册。）
