Stimulation induced variability of pulse plethysmography does not discriminate responsiveness to intubation

Luginbühl, Martin; Rüfenacht, M.; Korhonen, Ilkka; Gils, Mark van; Jakob, Stephan M.; Petersen-Felix, Steen

doi:10.1093/bja/aei315

Cited by 23 publications

(29 citation statements)

References 21 publications

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“…PPG is extremely sensitive to even the slightest movement, creating unacceptably large artifacts. We specifically chose not to use neuromuscular transmission monitors, because use of neuromuscular monitors is known to induce an electrical stimulus that results in peripheral vasoconstriction, thus, interfering with our data [3, 4, 7]. Despite the 3 min time interval between administration of rocuronium and endotracheal intubation, two patients moved their arms during intubation.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Tracheal Intubation-Induced Autonomic Response on Photoplethysmography

Talke

2017

Anesthesiology Research and Practice

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Introduction. Intraoperative stress responses and postoperative pain can be monitored using photoplethysmography (PPG). PPG signal has two components, AC and DC. Effects of noxious stimuli-induced stress responses have not been studied on the DC component of PPG. The aim of this study was to investigate the effect of a known noxious stimulus (endotracheal intubation) on both the AC and DC components of PPG. Methods. 15 surgical patients having general anesthesia were enrolled into this clinical study. PPG was recorded electronically from a pulse oximeter. Maximum changes in the AC and DC components of the PPG and pulse rate were determined in response to endotracheal intubation from high frequency (62.5 Hz) PPG recordings. Results. Endotracheal intubation-induced autonomic stress response resulted in a significant decrease in the AC component of the PPG and an increase in pulse rate in every subject (p < 0.05 for all). The decrease in the AC component of the PPG was 50 ± 12% (p < 0.05) and the increase in pulse rate was 26 ± 10 bpm (p < 0.05). The response of the DC component was variable (p = NS). Conclusion. Endotracheal intubation-induced stress response resulted in a significant and consistent change in the AC, but not the DC component of the PPG. This trial is registered with ClinicalTrials.gov Identifier NCT03032939.

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Section: Discussionmentioning

confidence: 99%

The Effect of Tracheal Intubation-Induced Autonomic Response on Photoplethysmography

Talke

2017

Anesthesiology Research and Practice

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“…In the study of ANS responses to nociception, however, the main interest is to use PPG to reflect sympathetic stress responses and vasoconstriction, and therefore transmission mode PPG seems a more appropriate choice. The studies published so far have focused on measurement sites with significant vasomotor control, especially on finger PPG 5–8,15 or laser Doppler flowmeter 3,4,16 . Finger PPG has been suggested as a better location than the ear because in the finger the walls of the cutaneous vessels are richly innervated by α‐adrenoceptors and hence the sensitivity to the sympathetic system is suggested to be better 13…”

Section: Signal Acquisitionmentioning

confidence: 99%

Photoplethysmography and nociception

Korhonen

Yli‐Hankala

2009

Acta Anaesthesiol Scand

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Photoplethysmography (PPG), i.e. pulse oximetric wave, is a non-invasive technique that is used in anaesthesia monitoring primarily to monitor blood oxygenation. The PPG waveform resembles that of the arterial blood pressure but instead of pressure it is related to the volume changes in the measurement site and hence contains information related to the peripheral blood circulation, including skin vasomotion, which is controlled by the sympathetic nervous system. Because of this link, skin vasomotor response and PPG amplitude response have been associated with nociception under general anaesthesia. Recently, there has been interest in monitoring nociception during general anaesthesia. In many of the published studies, PPG waveform information has been included. The focus of this topical review is to provide an overview on the information embedded in the PPG waveform especially in the context of the autonomic nervous system and analgesia monitoring.

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“…One method has been to calculate a mean value for a period [6,7,[20][21][22], the other method has been to calculate the peak value within a period [19]. In our study, tracheal intubation took different times for different patients, hence it was not suitable to calculate a mean value for an arbitrary period (e.g.…”

Section: Discussionmentioning

confidence: 89%

Changes in the photoplethysmogram with tracheal intubation and remifentanil concentration

Wang

Chen²,

et al. 2012

Anaesthesia

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SummaryAutonomic sympathetic activation, for instance following noxious stimuli, decreases the size and flattens the shape of the photoplethysmographic peripheral pulse waveform. We report a simple measure of the waveform shape, the ratio of mean-to-peak wave amplitude, for measuring nociception level during general anaesthesia. Fifty participants, anaesthetised with propofol and remifentanil, were randomly allocated to one of three different remifentanil effect-site concentrations (1, 3 and 5 ng.ml , were 0.49 (0.03), 0.48 (0.03) and 0.45 (0.04), respectively. Remifentanil therefore suppressed changes in the mean-to-peak ratio caused by tracheal intubation (p = 0.006). The ratio of the mean-to-peak plethysmographic amplitude may represent a simple measure of the balance of autonomic sympathetic and parasympathetic activity under general anaesthesia, and its performance following intubation was significantly different from peak amplitude (p = 0.046).

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Stimulation induced variability of pulse plethysmography does not discriminate responsiveness to intubation

Abstract: Tetanic stimulation induced PPG variation does not reflect the analgesic state in a wide clinical range of surgical anaesthesia.

Cited by 23 publications

References 21 publications

The Effect of Tracheal Intubation-Induced Autonomic Response on Photoplethysmography

The Effect of Tracheal Intubation-Induced Autonomic Response on Photoplethysmography

Photoplethysmography and nociception

Changes in the photoplethysmogram with tracheal intubation and remifentanil concentration

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