The Effect of Tracheal Intubation-Induced Autonomic Response on Photoplethysmography

Abstract

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.

Effect of the Location of Tetanic Stimulation on Autonomic Responses: A Randomized Cross-Over Pilot Study

“…18 Noxious stimuli-induced stress responses mediate peripheral vasoconstriction. 19,[21][22][23][24] This in turn, should decrease the AC component (reduced arterial pulsation) and increase the DC component (reduced venous and arterial blood volume) of the PPG, as observed in this study.…”

“…For example, temperature-induced vasoconstriction has a larger effect on the DC than on the AC component of the PPG, whereas intubation-induced noxious stimuli have a larger effect on the AC than on the DC component. [20][21][22][23][24] Our study adds to the current literature by analyzing the effect of a tetanic stimulus on both the AC and DC components and a derived variable (ACDC) of the PPG. Our data demonstrated that tetanic stimulus-mediated peripheral vasoconstriction has a larger effect on the AC and ACDC components of the PPG than on the DC component.…”

Evaluation of intravenous magnesium sulphate on haemodynamic responses to laryngoscopy and tracheal intubation in surgeries of ear, nose and throat

“…Elevated blood pressure, rapid heart rate, and high levels of adrenaline and norepinephrine are the most prominent outcomes of this response. [1][2][3][4] This response is usually transient, but elderly individuals and those with specific medical conditions-diabetes, heart failure, systemic arterial hypertension, coronary artery disease, cardiac arrhythmias, cerebrovascular disease, and pulmonary disordersmay be more susceptible to arrhythmias, myocardial ischemia or infarction, and cerebral haemorrhage. 5 Many strategies are being used to mitigate the hemodynamic reactions secondary to laryngoscopy and intubation.…”

Effect of labetalol and lignocaine on hemodynamic response to laryngoscopy and endotracheal intubation

“…The stimulation of the reninangiotensin system, which includes the release of renin from the renal juxta glomerular apparatus, which is innervated by -adrenergic nerve terminals, contributes to some of the hypertensive response to endotracheal intubation. Laryngoscopy and endotracheal intubation stimulate the central nervous system in addition to the autonomic nervous system, as shown by increases in electroencephalographic (EEG) activity, cerebral metabolic rate, and cerebral blood flow (CBF) [4]. The rise in CBF may cause high intracranial pressure (ICP) in patients with impaired intracranial compliance, leading to significant neurologic impairment and herniation of brain matter.…”