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Abstract

Assessment of Surgical Stress during General Anaesthesia

Assessing surgical stress during general anaesthesia: Toward a simple numerical measure

Inadequate analgesia during general anaesthesia may present as undesirable haemodynamic responses. No objective measures of the adequacy of analgesia exist. This study aimed to develop a surgical stress index (SSI)2 as a simple numerical measure of the level of surgical stress in an anaesthetized patient.

The performance of the SSI was validated during and before surgery, especially at skin incision and during changes of the predicted remifentanil effect-site concentration. The study found that the SSI reacts to surgical nociceptive stimuli and analgesic drug concentration changes during propofol-remifentanil anaesthesia. More studies are needed to evaluate the usefulness of under other anaesthetic and surgical conditions.

Surgical stress index (SSI) is presently known as Surgical Pleth Index™ (SPI), and is not available in the U.S., not 510(k) cleared.

M. Huiku, K. Uutela, M. van Gils, I. Korhonen, M. Kymäläinen, P. Meriläinen, M. Paloheimo, M. Rantanen, P. Takala, H. Viertiö-Oja and A. Yli-Hankala

Br. J. Anaesth. (2007) 98 (4): 447-455. (First published online: February 28, 2007)

Published with permission of the Oxford University Press for posting on GE Healthcare’s Clinical View: http://clinicalview.gehealthcare.com/

Background

Inadequate analgesia during general anaesthesia may present as undesirable haemodynamic responses. No objective measures of the adequacy of analgesia exist. We aimed at developing a simple numerical measure of the level of surgical stress in an anaesthetized patient.

Methods

Sixty and 12 female patients were included in the development and validation data sets, respectively. All patients had elective surgery with propofol–remifentanil target controlled anaesthesia. Finger photoplethysmography and electrocardiography waveforms were recorded throughout anaesthesia and various waveform parameters were extracted off-line. Total surgical stress (TSS) for a patient was estimated based on stimulus intensity and remifentanil concentration. The surgical stress index* (SSI) was developed to correlate with the TSS estimate in the development data set. The performance of SSI was validated within the validation data set during and before surgery, especially at skin incision and during changes of the predicted remifentanil effect-site concentration.

Results

SSI was computed as a combination of normalized heart beat interval (HBInorm) and plethysmographic pulse wave amplitude (PPGAnorm): SSI = 100–(0.7*PPGAnorm+0.3*HBInorm). SSI increased at skin incision and stayed higher during surgery than before surgery; SSI responded to remifentanil concentration changes and was higher at the lower concentrations of remifentanil.

CONCLUSIONS

SSI reacts to surgical nociceptive stimuli and analgesic drug concentration changes during propofol–remifentanil anaesthesia. Further validation studies of SSI are needed to elucidate its usefulness during other anaesthetic and surgical conditions.

Full article is available on the British Journal of Anaesthesia website
http://bja.oxfordjournals.org/content/98/4/447.full?sid=2a8a6158-1f97-43ea-b62e-481e90ae0137

Declaration of interest: M. Huiku, M. Kymäläinen, P. Meriläinen, M. Paloheimo, P. Takala, K. Uutela, and H. Viertiö-Oja are employees of GE Healthcare Finland Oy. M. Paloheimo and A. Yli-Hankala are medical advisors of GE Healthcare Finland Oy. M. Rantanen has received two research grants from GE Healthcare Finland Oy. VTT, Technical Research Centre of Finland, Tampere, has received financial support from GE Healthcare Finland Oy.

* Surgical stress index (SSI) is presently known as Surgical Pleth Index™ (SPI), and is not available in the U.S. and Canada.

  • Neurology
  • SPI
  • Perioperative care
  • Clinical