Stimulation induced variability of pulse plethysmography does not discriminate responsiveness to intubation

M. Luginbühl (Corresponding Author), M. Rüfenacht, Ilkka Korhonen, Mark van Gils, S. Jakob, S. Petersen-Felix

Research output: Contribution to journalArticleScientificpeer-review

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Abstract

Background: Hypnotic depth but not haemodynamic response to painful stimulation can be measured with various EEG-based anaesthesia monitors. We evaluated the variation of pulse plethysmography amplitude induced by an electrical tetanic stimulus (PPG variation) as a potential measure for analgesia and predictor of haemodynamic responsiveness during general anaesthesia.

Methods: Ninety-five patients, ASA I or II, were randomly assigned to five groups [Group 1: bispectral index (BIS) (range) 40–50, effect site remifentanil concentration 1 ng ml−1;Group 2: BIS 40–50, remifentanil 2 ng ml−1; Group 3: BIS 40–50, remifentanil 4 ng ml−1; Group 4: BIS 25–35, remifentanil 2 ng ml−1; Group 5: BIS 55–65, remifentanil 2 ng ml−1]. A 60 mA tetanic stimulus was applied for 5 s on the ulnar nerve. From the digitized pulse oximeter wave recorded on a laptop computer, linear and non-linear parameters of PPG variation during the 60 s period after stimulation were computed. The haemodynamic response to subsequent orotracheal intubation was recorded. The PPG variation was compared between groups and between responders and non-responders to intubation (anova). Variables independently predicting the response were determined by logistic regression.

Results: The probability of a response to tracheal intubation was 0.77, 0.47, 0.05, 0.18 and 0.52 in Groups 1–5, respectively (P<0.03). The PPG variability was significantly higher in responders than in non-responders but it did not improve the prediction of the response to tracheal intubation based on BIS level and effect site remifentanil concentration.

Conclusion: Tetanic stimulation induced PPG variation does not reflect the analgesic state in a wide clinical range of surgical anaesthesia.
Original languageEnglish
Pages (from-to)323-329
JournalBritish Journal of Anaesthesia
Volume96
Issue number3
DOIs
Publication statusPublished - 2006
MoE publication typeA1 Journal article-refereed

Fingerprint

Plethysmography
Intubation
Pulse
Hemodynamics
Anesthesia
Ulnar Nerve
Hypnotics and Sedatives
Analgesia
General Anesthesia
Analgesics
remifentanil
Electroencephalography
Logistic Models

Keywords

  • anaesthesia
  • depth of anaesthesia

Cite this

Luginbühl, M. ; Rüfenacht, M. ; Korhonen, Ilkka ; van Gils, Mark ; Jakob, S. ; Petersen-Felix, S. / Stimulation induced variability of pulse plethysmography does not discriminate responsiveness to intubation. In: British Journal of Anaesthesia. 2006 ; Vol. 96, No. 3. pp. 323-329.
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title = "Stimulation induced variability of pulse plethysmography does not discriminate responsiveness to intubation",
abstract = "Background: Hypnotic depth but not haemodynamic response to painful stimulation can be measured with various EEG-based anaesthesia monitors. We evaluated the variation of pulse plethysmography amplitude induced by an electrical tetanic stimulus (PPG variation) as a potential measure for analgesia and predictor of haemodynamic responsiveness during general anaesthesia.Methods: Ninety-five patients, ASA I or II, were randomly assigned to five groups [Group 1: bispectral index (BIS) (range) 40–50, effect site remifentanil concentration 1 ng ml−1;Group 2: BIS 40–50, remifentanil 2 ng ml−1; Group 3: BIS 40–50, remifentanil 4 ng ml−1; Group 4: BIS 25–35, remifentanil 2 ng ml−1; Group 5: BIS 55–65, remifentanil 2 ng ml−1]. A 60 mA tetanic stimulus was applied for 5 s on the ulnar nerve. From the digitized pulse oximeter wave recorded on a laptop computer, linear and non-linear parameters of PPG variation during the 60 s period after stimulation were computed. The haemodynamic response to subsequent orotracheal intubation was recorded. The PPG variation was compared between groups and between responders and non-responders to intubation (anova). Variables independently predicting the response were determined by logistic regression.Results: The probability of a response to tracheal intubation was 0.77, 0.47, 0.05, 0.18 and 0.52 in Groups 1–5, respectively (P<0.03). The PPG variability was significantly higher in responders than in non-responders but it did not improve the prediction of the response to tracheal intubation based on BIS level and effect site remifentanil concentration.Conclusion: Tetanic stimulation induced PPG variation does not reflect the analgesic state in a wide clinical range of surgical anaesthesia.",
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Stimulation induced variability of pulse plethysmography does not discriminate responsiveness to intubation. / Luginbühl, M. (Corresponding Author); Rüfenacht, M.; Korhonen, Ilkka; van Gils, Mark; Jakob, S.; Petersen-Felix, S.

In: British Journal of Anaesthesia, Vol. 96, No. 3, 2006, p. 323-329.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Stimulation induced variability of pulse plethysmography does not discriminate responsiveness to intubation

AU - Luginbühl, M.

AU - Rüfenacht, M.

AU - Korhonen, Ilkka

AU - van Gils, Mark

AU - Jakob, S.

AU - Petersen-Felix, S.

PY - 2006

Y1 - 2006

N2 - Background: Hypnotic depth but not haemodynamic response to painful stimulation can be measured with various EEG-based anaesthesia monitors. We evaluated the variation of pulse plethysmography amplitude induced by an electrical tetanic stimulus (PPG variation) as a potential measure for analgesia and predictor of haemodynamic responsiveness during general anaesthesia.Methods: Ninety-five patients, ASA I or II, were randomly assigned to five groups [Group 1: bispectral index (BIS) (range) 40–50, effect site remifentanil concentration 1 ng ml−1;Group 2: BIS 40–50, remifentanil 2 ng ml−1; Group 3: BIS 40–50, remifentanil 4 ng ml−1; Group 4: BIS 25–35, remifentanil 2 ng ml−1; Group 5: BIS 55–65, remifentanil 2 ng ml−1]. A 60 mA tetanic stimulus was applied for 5 s on the ulnar nerve. From the digitized pulse oximeter wave recorded on a laptop computer, linear and non-linear parameters of PPG variation during the 60 s period after stimulation were computed. The haemodynamic response to subsequent orotracheal intubation was recorded. The PPG variation was compared between groups and between responders and non-responders to intubation (anova). Variables independently predicting the response were determined by logistic regression.Results: The probability of a response to tracheal intubation was 0.77, 0.47, 0.05, 0.18 and 0.52 in Groups 1–5, respectively (P<0.03). The PPG variability was significantly higher in responders than in non-responders but it did not improve the prediction of the response to tracheal intubation based on BIS level and effect site remifentanil concentration.Conclusion: Tetanic stimulation induced PPG variation does not reflect the analgesic state in a wide clinical range of surgical anaesthesia.

AB - Background: Hypnotic depth but not haemodynamic response to painful stimulation can be measured with various EEG-based anaesthesia monitors. We evaluated the variation of pulse plethysmography amplitude induced by an electrical tetanic stimulus (PPG variation) as a potential measure for analgesia and predictor of haemodynamic responsiveness during general anaesthesia.Methods: Ninety-five patients, ASA I or II, were randomly assigned to five groups [Group 1: bispectral index (BIS) (range) 40–50, effect site remifentanil concentration 1 ng ml−1;Group 2: BIS 40–50, remifentanil 2 ng ml−1; Group 3: BIS 40–50, remifentanil 4 ng ml−1; Group 4: BIS 25–35, remifentanil 2 ng ml−1; Group 5: BIS 55–65, remifentanil 2 ng ml−1]. A 60 mA tetanic stimulus was applied for 5 s on the ulnar nerve. From the digitized pulse oximeter wave recorded on a laptop computer, linear and non-linear parameters of PPG variation during the 60 s period after stimulation were computed. The haemodynamic response to subsequent orotracheal intubation was recorded. The PPG variation was compared between groups and between responders and non-responders to intubation (anova). Variables independently predicting the response were determined by logistic regression.Results: The probability of a response to tracheal intubation was 0.77, 0.47, 0.05, 0.18 and 0.52 in Groups 1–5, respectively (P<0.03). The PPG variability was significantly higher in responders than in non-responders but it did not improve the prediction of the response to tracheal intubation based on BIS level and effect site remifentanil concentration.Conclusion: Tetanic stimulation induced PPG variation does not reflect the analgesic state in a wide clinical range of surgical anaesthesia.

KW - anaesthesia

KW - depth of anaesthesia

U2 - 10.1093/bja/aei315

DO - 10.1093/bja/aei315

M3 - Article

VL - 96

SP - 323

EP - 329

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

SN - 0007-0912

IS - 3

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