Surgical stress index reflects surgical stress in gynaecological laparoscopic day-case surgery †

Ahonen, Jouni; Jokela, R.; Uutela, K.; Huiku, M.

doi:10.1093/bja/aem035

Cited by 87 publications

(65 citation statements)

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“…The method of surgical stress index has been previously described in detail [3][4][5][6]. Heart beat interval and photoplethysmographic pulse wave data were collected via peripheral pulsoximetry using a S ⁄ 5 monitor (GE Healthcare), connected (Ethernet) to a laptop PC running data collection (S ⁄ 5 Collect, GE Healthcare) and surgical stress index (GE Healthcare) software.…”

Section: Methodsmentioning

confidence: 99%

“…In contrast to the number of fluctuations per second, the surgical stress index is not a raw parameter since, after normalisation of data, a score (0-100) is displayed. So far, the surgical stress index has shown a promising relationship with intra-operative painful stimuli [3][4][5][6], though it has not yet been tested in conscious subjects. Although the surgical stress index has been developed using baseline data of anaesthetised subjects, we hypothesised that the parameter could still reflect changes in sympathetic tone in awake patients and hence, similar to the number of fluctuations per second, reflect states of pain with reasonable accuracy.…”

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confidence: 99%

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Monitoring of sympathetic tone to assess postoperative pain: skin conductance vs surgical stress index

Ang²,

et al. 2009

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SummaryThe number of fluctuations in skin conductance per second has been described as a potential tool for monitoring postoperative pain. More recently, the surgical stress index has shown promising correlations with intra-operative painful stimuli. We compared both methods for their ability to assess postoperative pain, in 100 postoperative patients who were also asked to quantify their level of pain at different time points in the recovery room. The number of fluctuations per second and surgical stress index were significantly different between pain scoring £ 5 ⁄ 10 and > 5 ⁄ 10 on a numeric rating scale (mean (SE) number of fluctuations per second 0.12 (0.02) vs 0.21 (0.03), respectively; p = 0.017, and surgical stress index 57 (1.4) vs 64 (1.9) points, respectively; p = 0.001). Both number of fluctuations in skin conductance per second and surgical stress index identified timepoints with moderate to severe pain with only moderate sensitivity and specificity. Freedom from pain may be beneficial to postoperative outcome and overall healthcare costs. Timely assessment and treatment of pain is therefore crucial a part of perioperative care. However, most pain scores currently used in clinical practice rely on patients' cooperation and are hence bound to fail in unconscious, demented or uncooperative patients or young children. We have recently introduced the number of fluctuations in skin conductance per second as a potential tool for a more objective assessment of acute postoperative pain [1,2]. This parameter measures rapid changes in palmar sweat gland filling and thus sympathetic nervous activity.A second method for monitoring pain independent of patients' cooperation is the multiparameter approach of the surgical stress index (GE Healthcare, Helsinki, Finland), which combines assessment of cardiac sympathetic tone (via heart rate variability) with analysis of the peripheral plethysmographic pulse wave obtained from monitoring oxygen saturation. As the latter is strongly influenced by the sympathetically controlled peripheral vasoconstrictor tone, the surgical stress index may be described as a combined assessment of cardiac and peripheral sympathetic tone. In contrast to the number of fluctuations per second, the surgical stress index is not a raw parameter since, after normalisation of data, a score (0-100) is displayed. So far, the surgical stress index has shown a promising relationship with intra-operative painful stimuli [3][4][5][6], though it has not yet been tested in conscious subjects. Although the surgical stress index has been developed using baseline data of anaesthetised subjects, we hypothesised that the parameter could still reflect changes in sympathetic tone in awake patients and hence, similar to the number of fluctuations per second, reflect states of pain with reasonable accuracy.Therefore, the aim of our investigation was to test the surgical stress index in the recovery room setting and to compare its accuracy for identifying timepoints of moderate or severe pain with that of the num...

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Section: Methodsmentioning

confidence: 99%

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confidence: 99%

Monitoring of sympathetic tone to assess postoperative pain: skin conductance vs surgical stress index

Ang²,

et al. 2009

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“…The sensory and affective pain dimensions distinguished by MPQ were noted to be linked with different sites of activity in the brain (Zubieta et al 2001). Another way to quantify nociception is the surgical stress index (Ahonen et al 2007. None of these methods, however, are currently applicable in labour pain.…”

Section: Nature and Assessment Of Labour Painmentioning

confidence: 99%

Intravenous patient-controlled analgesia with remifentanil in early labour

Volmanen¹

2011

Acta Anaesthesiologica Scandinavica

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Cover design Raimo Ahonen JUVENES PRINT TAMPERE 2010Volmanen, Petri, Intravenous patient controlled analgesia with remifentanil in early labour. AbstractIn four prospective clinical trials, 114 parturients used intravenous patient-controlled remifentanil analgesia during the 1 st stage of labour. The median effective dose per bolus was ascertained to be 0.4 μg/kg and the pain scores were reduced with this by a median of 2 on a numerical scale (0-10). Compared with nitrous oxide, 15 parturients included in a cross-over study reported a larger reduction in pain scores during remifentanil analgesia (1.5 vs. 0.5, p = 0.001) and better pain relief scores (2.5 vs. 0.5 on a ranked five point scale 0-4, p < 0.001). In a parallel study including 45 parturients, epidural analgesia (EDA, 20 ml bupivacaine 0.625 mg/ml and fentanyl 2 μg/ml) was associated with lower pain scores (5.2 vs. 7.3 with remifentanil, p = 0.004) but variables related to satisfaction with analgesia (pain relief score, proportion of mothers with desire to continue with the given medication and termination of the study due to inadequate pain relief) were similar. A comparison of two methods for timing the remifentanil bolus during the uterine contraction cycle suggested that delaying the bolus does not improve analgesia. A period effect was noted in the cross-over trial with higher pain scores and increased drug consumption during the second study period suggesting acute hyperalgesia.Side effects of remifentanil analgesia included respiratory depression warranting oxygen supplementation in 33% of parturients. Sedation was experienced by the parturients using remifentanil and this was scored as stronger than sedation during nitrous oxide and EDA. The number of parturients with nausea did not increase during remifentanil analgesia. Other maternal side effects included dizziness, a difficulty in visual focusing and itching. Foetal heart rate tracing abnormalities were noted. The incidence of abnormal tracings and decreased UapH were not different, however, from that observed during nitrous oxide or EDA. Apgar scores at 1 and 5 minute indicated no neonatal depression. Keywords

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“…10 A similar study was carried out by Ahonen et al, who have shown strong correlations between SPI dynamics and pain-related stress management during gynecological laparoscopy interventions. 11 In conclusion, we can state that by implementing multimodal monitoring techniques in general anesthesia for controlled damage surgery can bring significant clinical benefits. Continuous noninvasive monitoring of the nociception-antinociception balance is responsible for adapting the analgesia management depending on the individual needs of each patient.…”

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confidence: 93%

Surgical Pleth Index™ (SPI)-Guided Analgesia during Damage Control Surgery in Trauma Patients

Rogobete¹,

Bedreag²,

Săndesc³

2017

Journal of Interdisciplinary Medicine

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Surgical stress index reflects surgical stress in gynaecological laparoscopic day-case surgery †

Abstract: 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.

Cited by 87 publications

References 20 publications

Monitoring of sympathetic tone to assess postoperative pain: skin conductance vs surgical stress index

Monitoring of sympathetic tone to assess postoperative pain: skin conductance vs surgical stress index

Intravenous patient-controlled analgesia with remifentanil in early labour

Surgical Pleth Index™ (SPI)-Guided Analgesia during Damage Control Surgery in Trauma Patients

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