Department of Large Animal Surgery, Anaesthesia and Orthopedics, Faculty of Veterinary Medicine, University of Ghent, Merelbeke, Belgium.
Animal Medicine and Surgery Department, Faculty of Veterinary Medicine, University of Cordoba, Cordoba, Spain.
Vet Q. 2023 Dec;43(1):1-9. doi: 10.1080/01652176.2023.2239311.
This study aimed to determine the performance of the averaged parasympathetic tone activity (PTAm) and its dynamic variation (ΔPTA) to assess intraoperative nociception in relation to heart rate (HR) and direct mean arterial pressure (MAP) in dogs undergoing laparoscopic ovariectomy. This prospective, observational, clinical study included 32 bitches. The PTAm, HR, MAP, and bispectral index (BIS) were assessed before (pre-stimulus), as well as 1 min and 2 min after, four surgical stimuli: insufflation, introduction of trocars, and removal of the left and right ovaries. A two-way ANOVA was performed to compare PTAm, HR, MAP, and BIS data across surgical stimuli. ≥ 20% drop in PTAm or ≥ 20% increase in HR and/or MAP regarding the pre-stimulus values was considered a PTAm-drop and/or a hemodynamic response, respectively. The performance of PTAm pre-stimulus, PTAm 1 min, and ΔPTA in predicting the hemodynamic response was assessed by calculation of the area under the receiver operating characteristic (ROC) curve. At insufflation, PTAm decreased after 1 ( = 0.010) and 2 ( = 0.045)min, and ΔPTA was different ( = 0.005) between dogs that presented hemodynamic response and dogs that did not. At PTAm-drop, MAP increased after 1 min ( = 0.001) and 2 min ( = 0.001) with respect to pre-stimulus value, whereas HR and BIS did not change. ROC curves showed a threshold value of PTAm pre-stimulus ≤51 to detect hemodynamic response (sensitivity 69%, specificity 52%). The PTAm and ΔPTA only assessed intraoperative nociception during insufflation. The PTAm pre-stimulus association to the hemodynamic response in anaesthetized dogs showed poor sensitivity and no specificity.
本研究旨在确定平均迷走神经张力活动 (PTAm) 的性能及其动态变化 (ΔPTA)，以评估接受腹腔镜卵巢切除术的犬的术中痛觉与心率 (HR) 和直接平均动脉压 (MAP) 的关系。这是一项前瞻性、观察性、临床研究，纳入了 32 只母犬。在术前（刺激前）、刺激后 1 分钟和 2 分钟，评估了 PTAm、HR、MAP 和双频谱指数 (BIS)，共进行了 4 次手术刺激：充气、引入套管针和切除左右卵巢。采用双向方差分析比较手术刺激前后的 PTAm、HR、MAP 和 BIS 数据。PTAm 下降 ≥ 20%或 HR 和/或 MAP 增加 ≥ 20%，相对于刺激前值，分别认为是 PTAm 下降和/或血流动力学反应。通过计算受试者工作特征 (ROC) 曲线下面积来评估 PTAm 刺激前、PTAm 1 分钟和 ΔPTA 预测血流动力学反应的性能。在充气时，PTAm 在 1 分钟 ( = 0.010) 和 2 分钟 ( = 0.045) 后下降，并且在出现血流动力学反应的犬和未出现血流动力学反应的犬之间，ΔPTA 不同 ( = 0.005)。在 PTAm 下降时，MAP 在刺激后 1 分钟 ( = 0.001) 和 2 分钟 ( = 0.001) 相对于刺激前值增加，而 HR 和 BIS 没有变化。ROC 曲线显示 PTAm 刺激前 ≤51 的阈值值可用于检测血流动力学反应 (敏感性 69%，特异性 52%)。PTAm 和 ΔPTA 仅在充气期间评估术中痛觉。麻醉犬 PTAm 刺激前与血流动力学反应的关联显示出较差的敏感性和无特异性。
