New parameters of skin conductance compared with bispectral index ® monitoring to assess emergence from total intravenous anaesthesia

Ledowski, Thomas; Preuss, James; Ford, Andrew H.; Paech, Michael J.; Mcternan, C.N.; Kapila, Rajeev Kumar; Schug, Stephan A.

doi:10.1093/bja/aem189

Cited by 14 publications

(9 citation statements)

References 16 publications

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“…However, a smaller number of intraoperative studies did not confirm these results and have even suggested the inferiority of SC as compared with BIS [27] or hemodynamic parameters and plasma noradrenaline levels [28]. Similarly to intraoperative probands, sedated ICU patients are isolated from various factors.…”

Section: Discussionmentioning

confidence: 94%

Acute Pain Therapy in Postanesthesia Care Unit Directed by Skin Conductance: A Randomized Controlled Trial

et al. 2012

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BackgroundAfter surgery, effective and well-directed acute pain therapy is a necessary and integral part of the overall treatment plan. Generally, the assessment of pain intensity depends on a patient’s self-evaluation using scoring systems such as numeric rating scales (NRS, 0 to 10). Recently, a “Pain Monitor” was commercially provided which is based on measurements of fluctuations of skin conductance (NFSC). In this randomized, controlled, single-blind trial, possible benefits of this certain device were studied.MethodsPostoperative patients (n = 44) were randomly assigned to a test or a control group during their stay in the postanesthesia care unit (PACU). All patients were treated and monitored according to internal hospital standards. Whereas all patients systematically evaluated their pain each 15 min, test group patients were additionally addressed when NFSC exceeded a predefined level. In cases of NRS≥5 during a routine elevation or in between, pain relief was achieved by standard procedures irrespective of group allocation.ResultsDuring their stay in PACU, both test and control groups experienced a significant decrease in NRS as a consequence of pain therapy. No significant differences in mean NRS or in NFSC values were found between the test and control groups. No correlation was observed between NRS and NFSC.ConclusionPostoperative patients experience diverse stressors, such as anxiety, disorientation, shivering, sickness and pain. Although the application of continuous pain monitoring would be meaningful in this clinical setting, the tested device failed to distinguish pain from other stressors in postoperative adult patients.Trial RegistrationGerman Clinical Trials Register DRKS00000755.

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Section: Discussionmentioning

confidence: 94%

Acute Pain Therapy in Postanesthesia Care Unit Directed by Skin Conductance: A Randomized Controlled Trial

et al. 2012

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“…2.3.1.4) to predict awakening from total intravenous anesthesia. However, these parameters had considerably lower predictabilities compared to the "bispectral index"; based on a complex EEG evaluation (Ledowski et al, 2007). Turkstra (1995) investigated SPRs 312 of 15 brain-injured patients in posttraumatic vegetative states (6 females, 9 males; aged 16-56 years) on their "best day" (determined by their arousal level regardless of EDA) following the presentation of startle stimuli consisting of a loud but not painful tone OR/habituation paradigm, and famous faces.…”

Section: Brain Lesionsmentioning

confidence: 87%

Electrodermal Activity

Boucsein

2012

1,619

1,589

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except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights.Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) Foreword to the Second EditionAs noted by David Lykken in the foreword to the first edition of this book, electrodermal activity was observed for the first time in Germany. A quartercentury later the scientific study of psychology also originated in Germany. Over time, however, the focus of psychological research, including the then new field of psychophysiology, shifted to the United States and Great Britain. This trend to the dominance of the United States and Great Britain was prolonged by the devastation of World War II and its aftermath in Germany (and elsewhere in continental Europe). Slowly at first and then more rapidly, German psychological science, including psychophysiology, recovered. For several decades German psychophysiologists have been a major force in psychophysiology. With the publication of the first English edition of this book in 1992, it became essential for electrodermal researchers worldwide again to learn from our German colleagues.When I came into psychophysiology in the mid-1960s, electrodermal activity was the most common system studied. Because of its popularity, a large literature had emerged on the physiological mechanisms producing these changes in the electrical properties of the skin and on the best methodology for recording them. Major reviews and/or chapters had been published or soon were to be published by Peter Venables and Irene Martin, Robert Edelberg, and David Lykken. Later reviews and articles were published by Venables and Margaret Christie, and by me. A chapter in 1990 by Michael Dawson, Anne Schell, and Diane Filion was especially noteworthy for its coverage of the psychological applications of electrodermal measures.Note that all these publications were journal articles and chapters and that most of them focused almost entirely on mechanisms and methodology. The publication of this book, first in German and then in English, provided the first book on electrodermal activity, and one that extensively covers psychological applications as well as mechanisms and methodology. Again to quote David Lykken back in 1992, "The return of German scholarship to what I shall loftily call the high table of psychophysiology is exemplified by this fine book, the most comprehensive treatise on the electrodermal system to appear in any language . . ." I completely agree with v that evaluation. Professor Boucsein's outstanding scholarship has produced a book of such breadth of coverage ...

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“…At emergence or during perioperative stimulations inducing a rise in the bispectral index above 50 , skin conductance parameters increased. The ability of skin conductance to predict clinical reactions or extubation, however, is still debated .…”

Section: Assessment Of Vascular Sympathetic Response To Nociceptive Smentioning

confidence: 99%

Monitoring depth of anesthesia: from consciousness to nociception. A window on subcortical brain activity

Constant

Sabourdin

2014

Pediatric Anesthesia

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Anesthesia results from several inhibitor processes, which interact to lead to loss of consciousness, amnesia, immobility, and analgesia. The anesthetic agents act on the whole brain, the cortical and subcortical areas according to their receptor targets. The conscious processes are rather integrated at the level of the cortical neuronal network, while the nonconscious processes such as the nociception or implicit memory require subcortical processing. A reliable and meaningful monitoring of depth of anesthesia should provide assessment of these different processes. Besides the EEG monitoring which gives mainly information on cortical anesthetic effects, it would be relevant to have also a subcortical feedback allowing an assessment of nociception. Several devices have been proposed in this last decade, to give us an idea of the analgesia/nociception balance. Up to now, most of them are based on the assessment of the autonomic response to noxious stimulation. Among the emerging clinical devices, we can mention those which assess vascular sympathetic response (skin conductance), cardiac and vascular sympathetic response (surgical pleth index), parasympathetic cardiac response (analgesia nociception index), and finally the pupillometry which is based on the assessment of the pupillary reflex dilatation induced by nociceptive stimulations. Basically, the skin conductance might be the most adapted to assess the stress in the awake or sedated neonate, while the performances of this method appear disappointing under anesthesia. The surgical pleth index is still poorly investigated in children. The analgesia nociception index showed promising results in adults, which have to be confirmed, especially in children and in infants, and lastly pupillometry, which can be considered as reliable and reactive in children as in adults, but which is still sometimes complicated in its use.

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New parameters of skin conductance compared with bispectral index ® monitoring to assess emergence from total intravenous anaesthesia

Abstract: AUC A and AUC B did not improve accuracy of SC monitoring in patients waking after TIVA.

Cited by 14 publications

References 16 publications

Acute Pain Therapy in Postanesthesia Care Unit Directed by Skin Conductance: A Randomized Controlled Trial

Acute Pain Therapy in Postanesthesia Care Unit Directed by Skin Conductance: A Randomized Controlled Trial

Electrodermal Activity

Monitoring depth of anesthesia: from consciousness to nociception. A window on subcortical brain activity

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