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) |
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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 |
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