EEG spectral entropy, heart rate, photoplethysmography and motor responses to skin incision during sevoflurane anaesthesia

Elina Seitsonen, Ilkka Korhonen, Mark van Gils, M. Huiku, Jyrki Lötjönen, K. Korttila, A. Yli-Hankala

Research output: Contribution to journalArticleScientificpeer-review

68 Citations (Scopus)

Abstract

Background: Analgesia is a part of balanced anaesthesia, but direct indicators of nociception do not exist. We examined the relationship between motor reactions and physiological variables during skin incision in sevoflurane anaesthesia and hypothesized that nociception could be detected and graded by significant changes in these variables.

Methods: Thirty‐one women scheduled for abdominal hysterectomy participated in the study. Anaesthesia was induced with fentanyl (1 µg kg−1), propofol (1 mg kg−1) and sevoflurane. Skin incision was performed 14 min after induction during 1.6% end‐tidal sevoflurane anaesthesia without neuromuscular blockade. Electrocardiography (ECG), photoplethysmography (PPG) and electroencephalography (EEG) were registered, and a range of variables was computed from these signals. The postincision values, normalized with respect to their preincision values, of movers vs. non‐movers were compared. The variables showing significant differences between movers and non‐movers were used to develop a logistic regression equation for the classification of patients into movers or non‐movers.

Results: Twenty‐six patients were eligible for analysis, and 12 (46%) displayed a motor reaction to skin incision (movers). Many ECG, PPG and EEG‐related variables showed significant differences between the pre‐ and postincision periods. The best classification performance, assessed by leave‐one‐out cross‐validation, between movers and non‐movers was achieved with the combination of response entropy of EEG, RR‐interval and PPG notch amplitude. The corresponding equation yielded 96% correct classification with 90% sensitivity and 100% specificity. The classification performance of any single variable alone was considerably worse.

Conclusion: Combination of information from different sources may be required for monitoring the adequacy of analgesia during anaesthesia.

Original languageEnglish
Pages (from-to)284-292
JournalActa Anaesthesiologica Scandinavica
Volume49
Issue number3
DOIs
Publication statusPublished - 2005
MoE publication typeA1 Journal article-refereed

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Photoplethysmography
Entropy
Electroencephalography
Anesthesia
Heart Rate
Skin
Nociception
Electrocardiography
Balanced Anesthesia
Anesthesia and Analgesia
Neuromuscular Blockade
Fentanyl
Propofol
Hysterectomy
Analgesia
Logistic Models
Sensitivity and Specificity
sevoflurane

Keywords

  • anaesthesia
  • depth of anaesthesia
  • analgesia

Cite this

Seitsonen, Elina ; Korhonen, Ilkka ; van Gils, Mark ; Huiku, M. ; Lötjönen, Jyrki ; Korttila, K. ; Yli-Hankala, A. / EEG spectral entropy, heart rate, photoplethysmography and motor responses to skin incision during sevoflurane anaesthesia. In: Acta Anaesthesiologica Scandinavica. 2005 ; Vol. 49, No. 3. pp. 284-292.
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title = "EEG spectral entropy, heart rate, photoplethysmography and motor responses to skin incision during sevoflurane anaesthesia",
abstract = "Background: Analgesia is a part of balanced anaesthesia, but direct indicators of nociception do not exist. We examined the relationship between motor reactions and physiological variables during skin incision in sevoflurane anaesthesia and hypothesized that nociception could be detected and graded by significant changes in these variables. Methods: Thirty‐one women scheduled for abdominal hysterectomy participated in the study. Anaesthesia was induced with fentanyl (1 µg kg−1), propofol (1 mg kg−1) and sevoflurane. Skin incision was performed 14 min after induction during 1.6{\%} end‐tidal sevoflurane anaesthesia without neuromuscular blockade. Electrocardiography (ECG), photoplethysmography (PPG) and electroencephalography (EEG) were registered, and a range of variables was computed from these signals. The postincision values, normalized with respect to their preincision values, of movers vs. non‐movers were compared. The variables showing significant differences between movers and non‐movers were used to develop a logistic regression equation for the classification of patients into movers or non‐movers. Results: Twenty‐six patients were eligible for analysis, and 12 (46{\%}) displayed a motor reaction to skin incision (movers). Many ECG, PPG and EEG‐related variables showed significant differences between the pre‐ and postincision periods. The best classification performance, assessed by leave‐one‐out cross‐validation, between movers and non‐movers was achieved with the combination of response entropy of EEG, RR‐interval and PPG notch amplitude. The corresponding equation yielded 96{\%} correct classification with 90{\%} sensitivity and 100{\%} specificity. The classification performance of any single variable alone was considerably worse. Conclusion: Combination of information from different sources may be required for monitoring the adequacy of analgesia during anaesthesia.",
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EEG spectral entropy, heart rate, photoplethysmography and motor responses to skin incision during sevoflurane anaesthesia. / Seitsonen, Elina; Korhonen, Ilkka; van Gils, Mark; Huiku, M.; Lötjönen, Jyrki; Korttila, K.; Yli-Hankala, A.

In: Acta Anaesthesiologica Scandinavica, Vol. 49, No. 3, 2005, p. 284-292.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - EEG spectral entropy, heart rate, photoplethysmography and motor responses to skin incision during sevoflurane anaesthesia

AU - Seitsonen, Elina

AU - Korhonen, Ilkka

AU - van Gils, Mark

AU - Huiku, M.

AU - Lötjönen, Jyrki

AU - Korttila, K.

AU - Yli-Hankala, A.

PY - 2005

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N2 - Background: Analgesia is a part of balanced anaesthesia, but direct indicators of nociception do not exist. We examined the relationship between motor reactions and physiological variables during skin incision in sevoflurane anaesthesia and hypothesized that nociception could be detected and graded by significant changes in these variables. Methods: Thirty‐one women scheduled for abdominal hysterectomy participated in the study. Anaesthesia was induced with fentanyl (1 µg kg−1), propofol (1 mg kg−1) and sevoflurane. Skin incision was performed 14 min after induction during 1.6% end‐tidal sevoflurane anaesthesia without neuromuscular blockade. Electrocardiography (ECG), photoplethysmography (PPG) and electroencephalography (EEG) were registered, and a range of variables was computed from these signals. The postincision values, normalized with respect to their preincision values, of movers vs. non‐movers were compared. The variables showing significant differences between movers and non‐movers were used to develop a logistic regression equation for the classification of patients into movers or non‐movers. Results: Twenty‐six patients were eligible for analysis, and 12 (46%) displayed a motor reaction to skin incision (movers). Many ECG, PPG and EEG‐related variables showed significant differences between the pre‐ and postincision periods. The best classification performance, assessed by leave‐one‐out cross‐validation, between movers and non‐movers was achieved with the combination of response entropy of EEG, RR‐interval and PPG notch amplitude. The corresponding equation yielded 96% correct classification with 90% sensitivity and 100% specificity. The classification performance of any single variable alone was considerably worse. Conclusion: Combination of information from different sources may be required for monitoring the adequacy of analgesia during anaesthesia.

AB - Background: Analgesia is a part of balanced anaesthesia, but direct indicators of nociception do not exist. We examined the relationship between motor reactions and physiological variables during skin incision in sevoflurane anaesthesia and hypothesized that nociception could be detected and graded by significant changes in these variables. Methods: Thirty‐one women scheduled for abdominal hysterectomy participated in the study. Anaesthesia was induced with fentanyl (1 µg kg−1), propofol (1 mg kg−1) and sevoflurane. Skin incision was performed 14 min after induction during 1.6% end‐tidal sevoflurane anaesthesia without neuromuscular blockade. Electrocardiography (ECG), photoplethysmography (PPG) and electroencephalography (EEG) were registered, and a range of variables was computed from these signals. The postincision values, normalized with respect to their preincision values, of movers vs. non‐movers were compared. The variables showing significant differences between movers and non‐movers were used to develop a logistic regression equation for the classification of patients into movers or non‐movers. Results: Twenty‐six patients were eligible for analysis, and 12 (46%) displayed a motor reaction to skin incision (movers). Many ECG, PPG and EEG‐related variables showed significant differences between the pre‐ and postincision periods. The best classification performance, assessed by leave‐one‐out cross‐validation, between movers and non‐movers was achieved with the combination of response entropy of EEG, RR‐interval and PPG notch amplitude. The corresponding equation yielded 96% correct classification with 90% sensitivity and 100% specificity. The classification performance of any single variable alone was considerably worse. Conclusion: Combination of information from different sources may be required for monitoring the adequacy of analgesia during anaesthesia.

KW - anaesthesia

KW - depth of anaesthesia

KW - analgesia

U2 - 10.1111/j.1399-6576.2005.00654.x

DO - 10.1111/j.1399-6576.2005.00654.x

M3 - Article

VL - 49

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EP - 292

JO - Acta Anaesthesiologica Scandinavica

JF - Acta Anaesthesiologica Scandinavica

SN - 0001-5172

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ER -