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Sufentanil administration guided by surgical pleth index vs standard practice during sevoflurane anaesthesia: a randomized controlled pilot study.
Br J Anaesth 2014; 112(5):898-905BJ

Abstract

BACKGROUND

Evaluation of analgesia and antinociception during anaesthesia is still a challenging issue and routinely based on indirect and non-specific signs such as movement, tachycardia, or lacrimation. Recently, the surgical pleth index (SPI) derived by finger plethysmography was introduced to detect nociceptive stimulation during anaesthesia. While SPI guidance reduced the number of unwanted events during total i.v. anaesthesia (TIVA), the impact of SPI during volatile-based anaesthesia with intermittent opioid administration has not yet been elucidated.

METHODS

Ninety-four patients were randomized into either SPI-guided analgesia or standard practice (Control). In both groups, anaesthesia was maintained with sevoflurane to keep bispectral index values between 40 and 60. In the SPI group, patients received a sufentanil bolus (10 μg) whenever SPI value increased above 50, whereas in the control group, sufentanil was administered according to standard clinical practice. The number of unwanted somatic events, haemodynamics, sufentanil consumption, and recovery times were recorded.

RESULTS

The incidence of intraoperative unwanted somatic events was comparable between the groups (P=0.89). No significant differences with respect to hypotensive or hypertensive events were found. The mean (95% confidence interval) sufentanil consumption was non-significantly (P=0.07) reduced in the SPI group, 0.64 (0.57-0.71) vs 0.78 (0.64-0.91) µg min(-1). Recovery times were comparable between the groups.

CONCLUSIONS

Sufentanil administration guided by SPI during sevoflurane anaesthesia is clinically feasible. In contrast to TIVA, it did not improve anaesthesia conduct with respect to unwanted somatic events, haemodynamic stability, sufentanil consumption, emergence time, or post-anaesthesia care unit care. Therefore, we conclude that anaesthesia regimen has an impact on beneficial effects by SPI guidance. Clinical trial registration NCT01525537. (Registered at Clinicaltrials.gov.).

Authors+Show Affiliations

Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig Holstein Campus Kiel, Schwanenweg 21, D-24105 Kiel, Germany.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24535604

Citation

Gruenewald, M, et al. "Sufentanil Administration Guided By Surgical Pleth Index Vs Standard Practice During Sevoflurane Anaesthesia: a Randomized Controlled Pilot Study." British Journal of Anaesthesia, vol. 112, no. 5, 2014, pp. 898-905.
Gruenewald M, Willms S, Broch O, et al. Sufentanil administration guided by surgical pleth index vs standard practice during sevoflurane anaesthesia: a randomized controlled pilot study. Br J Anaesth. 2014;112(5):898-905.
Gruenewald, M., Willms, S., Broch, O., Kott, M., Steinfath, M., & Bein, B. (2014). Sufentanil administration guided by surgical pleth index vs standard practice during sevoflurane anaesthesia: a randomized controlled pilot study. British Journal of Anaesthesia, 112(5), pp. 898-905. doi:10.1093/bja/aet485.
Gruenewald M, et al. Sufentanil Administration Guided By Surgical Pleth Index Vs Standard Practice During Sevoflurane Anaesthesia: a Randomized Controlled Pilot Study. Br J Anaesth. 2014;112(5):898-905. PubMed PMID: 24535604.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sufentanil administration guided by surgical pleth index vs standard practice during sevoflurane anaesthesia: a randomized controlled pilot study. AU - Gruenewald,M, AU - Willms,S, AU - Broch,O, AU - Kott,M, AU - Steinfath,M, AU - Bein,B, Y1 - 2014/02/16/ PY - 2014/2/19/entrez PY - 2014/2/19/pubmed PY - 2014/7/6/medline KW - anaesthesia, general KW - anaesthetics volatile, sevoflurane KW - analgesia KW - equipment and monitors SP - 898 EP - 905 JF - British journal of anaesthesia JO - Br J Anaesth VL - 112 IS - 5 N2 - BACKGROUND: Evaluation of analgesia and antinociception during anaesthesia is still a challenging issue and routinely based on indirect and non-specific signs such as movement, tachycardia, or lacrimation. Recently, the surgical pleth index (SPI) derived by finger plethysmography was introduced to detect nociceptive stimulation during anaesthesia. While SPI guidance reduced the number of unwanted events during total i.v. anaesthesia (TIVA), the impact of SPI during volatile-based anaesthesia with intermittent opioid administration has not yet been elucidated. METHODS: Ninety-four patients were randomized into either SPI-guided analgesia or standard practice (Control). In both groups, anaesthesia was maintained with sevoflurane to keep bispectral index values between 40 and 60. In the SPI group, patients received a sufentanil bolus (10 μg) whenever SPI value increased above 50, whereas in the control group, sufentanil was administered according to standard clinical practice. The number of unwanted somatic events, haemodynamics, sufentanil consumption, and recovery times were recorded. RESULTS: The incidence of intraoperative unwanted somatic events was comparable between the groups (P=0.89). No significant differences with respect to hypotensive or hypertensive events were found. The mean (95% confidence interval) sufentanil consumption was non-significantly (P=0.07) reduced in the SPI group, 0.64 (0.57-0.71) vs 0.78 (0.64-0.91) µg min(-1). Recovery times were comparable between the groups. CONCLUSIONS: Sufentanil administration guided by SPI during sevoflurane anaesthesia is clinically feasible. In contrast to TIVA, it did not improve anaesthesia conduct with respect to unwanted somatic events, haemodynamic stability, sufentanil consumption, emergence time, or post-anaesthesia care unit care. Therefore, we conclude that anaesthesia regimen has an impact on beneficial effects by SPI guidance. Clinical trial registration NCT01525537. (Registered at Clinicaltrials.gov.). SN - 1471-6771 UR - https://www.unboundmedicine.com/medline/citation/24535604/Sufentanil_administration_guided_by_surgical_pleth_index_vs_standard_practice_during_sevoflurane_anaesthesia:_a_randomized_controlled_pilot_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0007-0912(17)30841-3 DB - PRIME DP - Unbound Medicine ER -