BJA Advance Access published online on March 9, 2007
British Journal of Anaesthesia, doi:10.1093/bja/aem035
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Surgical stress index reflects surgical stress in gynaecological laparoscopic day-case surgery
1 Department of Anaesthesia and Intensive Care Medicine, Helsinki University Hospital, Helsinki, Finland
2 GE Healthcare Finland, Helsinki, Finland
* Corresponding author: Department of Anaesthesia and Intensive Care Medicine, Helsinki University Hospital, PO Box 140, FIN-00029 HUS, Finland. E-mail: jouni.ahonen{at}fimnet.fi
Background: Monitoring of analgesia remains a challenge during general anaesthesia. The surgical stress index (SSI) is derived from the photoplethysmographic waveform amplitude and the heart beat-to-beat interval. We evaluated the ability of SSI to measure surgical stress in patients undergoing gynaecological laparoscopy. Our hypothesis was that while keeping State EntropyTM (SE) at a predetermined level, SSI would be higher in patients receiving a ß-blocking agent (esmolol) than in those receiving an opioid (remifentanil) during laparoscopy.
Methods: Thirty women undergoing gynaecological laparoscopy were assigned randomly to receive esmolol (n=15) or remifentanil (n=15). Anaesthesia was induced with propofol and fentanyl and maintained with desflurane and nitrous oxide 50% in oxygen to keep SE at 50(5). The infusion of esmolol or remifentanil was started before laparoscopy and adjusted to keep the systolic blood pressure at –20 to +10% from the preoperative value.
Results: During the fentanyl phase, before surgery, both groups behaved similarly, with an increase in SSI after intubation. In the patients receiving esmolol, the SSI reacted to the initial incision (P<0.05), and remained high after trocar insertion (P<0.05). In patients receiving remifentanil, it did not react to the initial incision, but increased after trocar insertion (P<0.05), and it remained lower both after incision (P<0.05) and after trocar insertion (P<0.05).
Conclusion: SSI was higher in patients receiving esmolol. The index seems to reflect the level of surgical stress and may help guide the use of opioids during general anaesthesia.
Keywords: adrenergic ß-antagonists, esmolol; analgesia, opioid, remifentanil; monitoring, depth of anaesthesia; surgery, laparoscopy; surgical stress index, nociception
Declaration of interest. Dr Ahonen and Dr Jokela have received a data-collecting program from GE Healthcare for their previous study (Valjus, et al. Acta Anaesthesiol Scand 2006; 50: 32–9). Dr Uutela and Dr Huiku are employees of GE Healthcare, Finland. The salaries of the study nurses were paid by GE Healthcare, Finland.
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