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 language | English (US) |
|---|---|
| Pages (from-to) | 441-449 |
| Number of pages | 9 |
| Journal | Journal of Clinical Monitoring and Computing |
| Volume | 26 |
| Issue number | 6 |
| DOIs | |
| State | Published - Dec 2012 |
| Externally published | Yes |
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Keywords
- Acute
- Analgesia
- Anesthesia
- Antinociception
- Beat-by-beat
- BIS
- Blood pressure
- CARDEAN
- Depth of anesthesia
- Electroencephalogram
- Heart rate
- Nociception
- Pain
- Surgery
ASJC Scopus subject areas
- Anesthesiology and Pain Medicine
- Critical Care and Intensive Care Medicine
- Health Informatics
Cite this
A beat-by-beat, on-line, cardiovascular index, CARDEAN, to assess circulatory responses to surgery : A randomized clinical trial during spine surgery. / Rossi, M.; Cividjian, A.; Fevre, M. C.; Oddoux, M. E.; Carcey, J.; Halle, C.; Frost, M.; Gardellin, M.; Payen, J. F.; Quintin, L.
In: Journal of Clinical Monitoring and Computing, Vol. 26, No. 6, 12.2012, p. 441-449.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - A beat-by-beat, on-line, cardiovascular index, CARDEAN, to assess circulatory responses to surgery
T2 - A randomized clinical trial during spine surgery
AU - Rossi, M.
AU - Cividjian, A.
AU - Fevre, M. C.
AU - Oddoux, M. E.
AU - Carcey, J.
AU - Halle, C.
AU - Frost, M.
AU - Gardellin, M.
AU - Payen, J. F.
AU - Quintin, L.
PY - 2012/12
Y1 - 2012/12
N2 - 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.
AB - 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.
KW - Acute
KW - Analgesia
KW - Anesthesia
KW - Antinociception
KW - Beat-by-beat
KW - BIS
KW - Blood pressure
KW - CARDEAN
KW - Depth of anesthesia
KW - Electroencephalogram
KW - Heart rate
KW - Nociception
KW - Pain
KW - Surgery
UR - http://www.scopus.com/inward/record.url?scp=84877138104&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84877138104&partnerID=8YFLogxK
U2 - 10.1007/s10877-012-9372-y
DO - 10.1007/s10877-012-9372-y
M3 - Article
C2 - 22684738
AN - SCOPUS:84877138104
VL - 26
SP - 441
EP - 449
JO - Journal of Clinical Monitoring and Computing
JF - Journal of Clinical Monitoring and Computing
SN - 1387-1307
IS - 6
ER -