BJA Advance Access originally published online on February 28, 2007
British Journal of Anaesthesia 2007 98(4):447-455; doi:10.1093/bja/aem004
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Assessment of surgical stress during general anaesthesia
1 Clinical Research, GE Healthcare Finland Oy, PO Box 900, FI-00031 GE, Helsinki, Finland
2 VTT, Technical Research Centre of Finland, PO Box 1300, FI-33101 Tampere, Finland
3 Department of Anaesthesia, ENT and Eye Hospital, Helsinki University Central Hospital, PO Box 340, FI-00029 HUS, Helsinki, Finland
4 Department of Anaesthesia, Tampere University Hospital, PO Box 2000, FI-33521 Tampere, Finland
5 Medical School, University of Tampere, FI-33014 Tampere, Finland
* Corresponding author: Clinical Research, GE Healthcare Finland Oy, PO Box 900, FI-00031 GE, Finland. E-mail: matti.huiku{at}ge.com
Background: Inadequate analgesia during general anaesthesia may present as undesirable haemodynamic responses. No objective measures of the adequacy of analgesia exist. We aimed at developing a simple numerical measure of the level of surgical stress in an anaesthetized patient.
Methods: Sixty and 12 female patients were included in the development and validation data sets, respectively. All patients had elective surgery with propofol–remifentanil target controlled anaesthesia. Finger photoplethysmography and electrocardiography waveforms were recorded throughout anaesthesia and various waveform parameters were extracted off-line. Total surgical stress (TSS) for a patient was estimated based on stimulus intensity and remifentanil concentration. The surgical stress index (SSI) was developed to correlate with the TSS estimate in the development data set. The performance of SSI was validated within the validation data set during and before surgery, especially at skin incision and during changes of the predicted remifentanil effect-site concentration.
Results: SSI was computed as a combination of normalized heart beat interval (HBInorm) and plethysmographic pulse wave amplitude (PPGAnorm): SSI = 100–(0.7*PPGAnorm+0.3*HBInorm). SSI increased at skin incision and stayed higher during surgery than before surgery; SSI responded to remifentanil concentration changes and was higher at the lower concentrations of remifentanil.
Conclusions: SSI reacts to surgical nociceptive stimuli and analgesic drug concentration changes during propofol–remifentanil anaesthesia. Further validation studies of SSI are needed to elucidate its usefulness during other anaesthetic and surgical conditions.
Keywords: anaesthetics i.v., propofol; analgesics opioid, remifentanil; blood, flow, peripheral; cardiovascular system, responses; monitoring, pulse oximeter
Declaration of interest. M. Huiku, M. Kymäläinen, P. Meriläinen, M. Paloheimo, P. Takala, K. Uutela, and H. Viertiö-Oja are employees of GE Healthcare Finland Oy. M. Paloheimo and A. Yli-Hankala are medical advisors of GE Healthcare Finland Oy. M. Rantanen has received two research grants from GE Healthcare Finland Oy. VTT, Technical Research Centre of Finland, Tampere, has received financial support from GE Healthcare Finland Oy.
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