Adequacy of Anesthesia and Pupillometry for Endoscopic Sinus Surgery

Abstract

Inadequate intraoperative analgesia causes the deterioration of the condition of the surgical field (CSF) as a result of hemodynamic instability. Analgesia monitors are used to guide remifentanil) infusion to optimize intraoperative analgesia. The main aim of the current randomized controlled trial was to investigate the potential advantages of intraoperative analgesia monitoring using surgical Pleth index (SPI)- or pupillometry (PRD)-guided remifentanil administration for managing the volume of total intraoperative blood loss (TEIBL), CSF, and length of operation (LOP) in comparison with the standard practice in patients undergoing endoscopic sinus surgery (ESS). The 89 patients in our study were grouped as follows: 30 patients were assigned to the general analgesia (GA) group, 31 patients were assigned to the SPI group, and 28 patients were assigned to the PRD group. The speed of remifentanil infusion was accelerated by 50% when SPI, PRD, or BSS were increased by >15 points, >5%, or >2, respectively, in adjacent groups until their normalization. The SPI group showed significantly lower TEIBL in comparison to the GA group (165.2 ± 100.2 vs. 283.3 ± 193.5 mL; p < 0.05) and a higher mean arterial pressure (MAP; 73.9 ± 8 vs. 69.2 ± 6.8 mmHg; p < 0.05). In the PRD group, a shorter LOP compared with the GA group was observed (63.1 ± 26.7 min vs. 82.6 ± 33.1 min; p < 0.05). It was noted that the PRD group had a lower total remifentanil consumption than the SPI group (1.3 ± 1.4 vs. 1.8 ± 0.9 mg; p < 0.05). In ASA I-III patients undergoing ESS, intraoperative monitoring based on state entropy and SPI values can optimize the CSF and reduce TEIBL, whereas monitoring based on state entropy and PRD measurements can optimize the cost effectiveness of anesthetic drugs and the use of the operation room.

Does surgical plethysmographic index-guided analgesia affect opioid requirement and extubation time? A systematic review and meta-analysis

“…The age of the participants ranged from 3 to 74 years. They had an American Society of Anesthesiologists physical status classification of I–III, and underwent elective surgery including orthopedic surgery [ 25 – 27 ], ear–nose–throat surgery [ 11 , 27 , 28 ], laparoscopic cholecystectomy [ 19 , 21 , 29 , 30 ], radical retropubic prostatectomy [ 20 , 22 ], gynecological surgery [ 26 , 27 ], thyroidectomy [ 12 ], adenotonsillectomy [ 31 ], maxillofacial, and trauma surgery [ 27 ].…”

“…The anesthesiologists increased the opioid dosage if the SPI was > 50 and if it persisted for > 15 s. The attending anesthesiologists adjusted the opioid dosage to maintain the SPI value within a defined range. However, regarding the control group, in nine studies [ 11 , 12 , 19 , 25 , 26 , 28 – 31 ], opioid administration was adjusted carefully according to “inadequate anesthesia,” which was defined as either heart rate (HR) or mean arterial pressure (MAP) increasing > 20% above the baseline. In the other four studies [ 20 – 22 , 27 ], opioid administration was adjusted according to the individual clinical practice by the anesthesiologist without any standard guidelines.…”

“…This study focused on whether the use of SPI to guide opioid administration reduced opioid requirement and effectively accelerated recovery after surgery, in line with ERAS. In comparison with the number of RCTs included in the previous meta-analyses [ 15 – 18 ], we included seven more RCTs [ 19 – 22 , 27 , 28 , 30 ]. Our meta-analysis, including 13 RCTs, revealed no significant decrease in intraoperative opioid consumption, but effectively demonstrated shortened extubation and eye-opening times in the SPI-guided group.…”

Adequacy of Anaesthesia for Nociception Detection during Vitreoretinal Surgery

“…Our study has some limitations. As in other studies concerning the utility of AoA guidance for GA in patients undergoing different surgical procedures, we adopted a protocol in which IROA was administered in the case of ∆SPI >15 [ 8 , 9 , 10 , 30 , 31 , 32 ] to avoid miscalculation and the possibly hazardous overdosage of IROA. This was already precisely described with a more strict protocol, although the current literature reports that ∆SPI >10 or any SPI >50 constitute an indication for IROA.…”

Adverse Events during Vitreoretinal Surgery under Adequacy of Anesthesia Guidance—Risk Factor Analysis

“…Its administration could have proportionally affected the final rate of incidence of PONV. Third, as shown in the current literature, there is no consistent algorithm for the titration of IRNA available, which could be due to the on-line observation of fluctuations in the SPI value [59]; therefore, we adopted a methodology of IRNA titration from our previous studies [60][61][62][63][64].…”