Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Gurodong-Ro 148, Guro-Gu, Seoul, 08308, Republic of Korea.
BMC Anesthesiol. 2023 Feb 17;23(1):57. doi: 10.1186/s12871-023-02011-5.
During general anesthesia, the surgical pleth index (SPI) monitors nociception. The evidence of SPI in the elderly remains scarce. We aimed to investigate whether there is a difference in perioperative outcomes following intraoperative opioid administration according to the surgical pleth index (SPI) value versus hemodynamic parameters (heart rate or blood pressure) in elderly patients.
Patients aged 65-90 years who underwent laparoscopic colorectal cancer surgery under sevoflurane/remifentanil anesthesia were randomized to receive remifentanil guided by SPI (SPI group) or conventional clinical judgment based on hemodynamic parameters (conventional group). The primary endpoint was intraoperative remifentanil consumption. Secondary endpoints were intraoperative hemodynamic instability, pain score, fentanyl consumption and delirium in the post-anesthesia care unit (PACU), and perioperative changes in interleukin-6 and natural killer (NK) cell activity.
Seventy-five patients (38, SPI; 37, conventional) were included in the study. The SPI group consumed significantly more remifentanil intraoperatively than the conventional group (mean ± SD, 0.13 ± 0.05 vs. 0.06 ± 0.04 μg/kg/min, P < 0.001). Intraoperative hypertension and tachycardia were more common in the conventional group than in the SPI group. Pain score in the PACU (P = 0.013) and the incidence of delirium in the PACU were significantly lower in the SPI group than the conventional group (5.2% vs. 24.3%, P = 0.02). There was no significant difference in NK cell activity and interleukin-6 level.
In the elderly patients, SPI-guided analgesia provided appropriate analgesia with sufficient intraoperative remifentanil consumption, lower incidence of hypertension/ tachycardia events, and a lower incidence of delirium in the PACU than the conventional analgesia. However, SPI-guided analgesia may not prevent perioperative immune system deterioration.
The randomized controlled trial was retrospectively registered in the UMIN Clinical Trials Registry (trial number: UMIN000048351; date of registration: 12/07/2022).
在全身麻醉期间，手术 pleth 指数（SPI）可监测伤害感受。老年人的 SPI 证据仍然很少。我们旨在研究在接受七氟醚/瑞芬太尼麻醉的老年患者中，根据手术 pleth 指数（SPI）值与心率或血压等血流动力学参数相比，术中给予阿片类药物后围手术期结局是否存在差异。
接受腹腔镜结直肠癌手术的 65-90 岁患者随机分为接受瑞芬太尼引导的 SPI 组（SPI 组）或基于血流动力学参数的常规临床判断组（常规组）。主要终点是术中瑞芬太尼的消耗量。次要终点是术中血流动力学不稳定、疼痛评分、麻醉后护理单元（PACU）中的芬太尼消耗量和谵妄，以及围手术期白细胞介素-6 和自然杀伤（NK）细胞活性的变化。
共有 75 名患者（38 名，SPI 组；37 名，常规组）纳入研究。SPI 组术中瑞芬太尼的消耗量明显多于常规组（平均值±标准差，0.13±0.05 与 0.06±0.04μg/kg/min，P<0.001）。常规组术中高血压和心动过速更为常见。SPI 组 PACU 中的疼痛评分（P=0.013）和 PACU 中谵妄的发生率明显低于常规组（5.2%与 24.3%，P=0.02）。NK 细胞活性和白细胞介素-6 水平无显著差异。
在老年患者中，SPI 引导的镇痛可提供适当的镇痛，术中瑞芬太尼的消耗量充足，高血压/心动过速事件的发生率较低，PACU 中谵妄的发生率低于常规镇痛。然而，SPI 引导的镇痛可能无法预防围手术期免疫系统恶化。
这项随机对照试验在 UMIN 临床试验注册中心（注册号：UMIN000048351；注册日期：2022 年 12 月 7 日）进行了回顾性注册。
