A beat-by-beat, on-line, cardiovascular index, CARDEAN, to assess circulatory responses to surgery: A randomized clinical trial during spine surgery

M. Rossi, A. Cividjian, M. C. Fevre, M. E. Oddoux, J. Carcey, C. Halle, M. Frost, M. Gardellin, J. F. Payen, L. Quintin

Research output: Contribution to journalArticlepeer-review

Abstract

Automated assessment of circulatory response to surgical stimuli is unsolved. Would detection of cardiac baroreflex inhibition assess adequacy of intra-operative anti-nociception upon incision, as performed on-line on a beat-by-beat basis by a cardiovascular index, CARDEAN™? 18 ASA I-II patients undergoing spinal disc repair were studied, in a prospective randomized single-blinded trial (observational study). During infusion of propofol to maintain bispectral index between 40 and 60, patients were allocated to receive an effect site target-controlled infusion of remifentanil at Ce = 2 or 4 ng ml-1. Upon incision and during surgery, circulatory response was assessed using beat-by-beat measurements of minor hypertension and tachycardia to give a cardiovascular index, CARDEAN, scaled between 0 and 100. Upon skin incision, CARDEAN increased in the remifentanil Ce = 2 ng ml-1 group (n = 7, P < 0.05), while it did not increase in the remifentanil Ce = 4 ng ml-1 group (n = 7, P = 0.18). During surgery, retrospectively, CARDEAN > 60 was associated with tachycardia and hypertension (P k = 0.81 ± 0.10). Changes in CARDEAN appeared linked to adequacy of anti-nociception.

Original languageEnglish (US)
Pages (from-to)441-449
Number of pages9
JournalJournal of Clinical Monitoring and Computing
Volume26
Issue number6
DOIs
StatePublished - Dec 2012

Keywords

  • Acute
  • Analgesia
  • Anesthesia
  • Antinociception
  • BIS
  • Beat-by-beat
  • Blood pressure
  • CARDEAN
  • Depth of anesthesia
  • Electroencephalogram
  • Heart rate
  • Nociception
  • Pain
  • Surgery

ASJC Scopus subject areas

  • Health Informatics
  • Critical Care and Intensive Care Medicine
  • Anesthesiology and Pain Medicine

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