Assessment of surgical stress during general anaesthesia

Matti Huiku, Minna Kymäläinen, Panu Takala, Kimmo Uutela, Hanna Viertiö-Oja, Markku Rantanen, Mark van Gils, Ilkka Korhonen, Arvi Yli-Hankala

Research output: Contribution to journalArticleScientificpeer-review

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Abstract

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.
Original languageEnglish
Pages (from-to)447-455
JournalBritish Journal of Anaesthesia
Volume98
Issue number4
DOIs
Publication statusPublished - 2007
MoE publication typeA1 Journal article-refereed

Fingerprint

General Anesthesia
Anesthesia
Analgesia
Photoplethysmography
Skin
Validation Studies
Fingers
Analgesics
Pulse
Anesthetics
Electrocardiography
Hemodynamics
remifentanil
Datasets

Keywords

  • anaesthetics i.v., propofol
  • analgesics opioid, remifentanil
  • blood, flow, peripheral
  • cardiovascular system, responses
  • monitoring, pulse oximeter

Cite this

Huiku, M., Kymäläinen, M., Takala, P., Uutela, K., Viertiö-Oja, H., Rantanen, M., ... Yli-Hankala, A. (2007). Assessment of surgical stress during general anaesthesia. British Journal of Anaesthesia, 98(4), 447-455. https://doi.org/10.1093/bja/aem004
Huiku, Matti ; Kymäläinen, Minna ; Takala, Panu ; Uutela, Kimmo ; Viertiö-Oja, Hanna ; Rantanen, Markku ; van Gils, Mark ; Korhonen, Ilkka ; Yli-Hankala, Arvi. / Assessment of surgical stress during general anaesthesia. In: British Journal of Anaesthesia. 2007 ; Vol. 98, No. 4. pp. 447-455.
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abstract = "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.",
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Huiku, M, Kymäläinen, M, Takala, P, Uutela, K, Viertiö-Oja, H, Rantanen, M, van Gils, M, Korhonen, I & Yli-Hankala, A 2007, 'Assessment of surgical stress during general anaesthesia', British Journal of Anaesthesia, vol. 98, no. 4, pp. 447-455. https://doi.org/10.1093/bja/aem004

Assessment of surgical stress during general anaesthesia. / Huiku, Matti; Kymäläinen, Minna; Takala, Panu; Uutela, Kimmo; Viertiö-Oja, Hanna; Rantanen, Markku; van Gils, Mark; Korhonen, Ilkka; Yli-Hankala, Arvi.

In: British Journal of Anaesthesia, Vol. 98, No. 4, 2007, p. 447-455.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Assessment of surgical stress during general anaesthesia

AU - Huiku, Matti

AU - Kymäläinen, Minna

AU - Takala, Panu

AU - Uutela, Kimmo

AU - Viertiö-Oja, Hanna

AU - Rantanen, Markku

AU - van Gils, Mark

AU - Korhonen, Ilkka

AU - Yli-Hankala, Arvi

PY - 2007

Y1 - 2007

N2 - 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.

AB - 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.

KW - anaesthetics i.v., propofol

KW - analgesics opioid, remifentanil

KW - blood, flow, peripheral

KW - cardiovascular system, responses

KW - monitoring, pulse oximeter

U2 - 10.1093/bja/aem004

DO - 10.1093/bja/aem004

M3 - Article

VL - 98

SP - 447

EP - 455

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

SN - 0007-0912

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Huiku M, Kymäläinen M, Takala P, Uutela K, Viertiö-Oja H, Rantanen M et al. Assessment of surgical stress during general anaesthesia. British Journal of Anaesthesia. 2007;98(4):447-455. https://doi.org/10.1093/bja/aem004