Effect of surgical pleth index-guided remifentanil administration on perioperative outcomes in elderly patients: a prospective randomized controlled trial

BMC Anesthesiology

Research

Young Ju Won¹  Jae Hak Lee¹  Seok Kyeong Oh¹  Do Yeop Lee¹  Byung Gun Lim¹  Young Sung Kim¹ 

[1] Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Gurodong-Ro 148, Guro-Gu, 08308, Seoul, Republic of Korea;

关键词: Surgical pleth index;    Opioid analgesics;    Nociception;    Aged;    Delirium;    NK cell activity;   

DOI  :  10.1186/s12871-023-02011-5

 received in 2022-08-25, accepted in 2023-02-03,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundDuring general anesthesia, the surgical pleth index (SPI) monitors nociception. The evidence of SPI in the elderly remains scarce. We aimed to investigate whether there is a difference in perioperative outcomes following intraoperative opioid administration according to the surgical pleth index (SPI) value versus hemodynamic parameters (heart rate or blood pressure) in elderly patients.MethodsPatients aged 65–90 years who underwent laparoscopic colorectal cancer surgery under sevoflurane/remifentanil anesthesia were randomized to receive remifentanil guided by SPI (SPI group) or conventional clinical judgment based on hemodynamic parameters (conventional group). The primary endpoint was intraoperative remifentanil consumption. Secondary endpoints were intraoperative hemodynamic instability, pain score, fentanyl consumption and delirium in the post-anesthesia care unit (PACU), and perioperative changes in interleukin-6 and natural killer (NK) cell activity.ResultsSeventy-five patients (38, SPI; 37, conventional) were included in the study. The SPI group consumed significantly more remifentanil intraoperatively than the conventional group (mean ± SD, 0.13 ± 0.05 vs. 0.06 ± 0.04 μg/kg/min, P < 0.001). Intraoperative hypertension and tachycardia were more common in the conventional group than in the SPI group. Pain score in the PACU (P = 0.013) and the incidence of delirium in the PACU were significantly lower in the SPI group than the conventional group (5.2% vs. 24.3%, P = 0.02). There was no significant difference in NK cell activity and interleukin-6 level.ConclusionsIn the elderly patients, SPI-guided analgesia provided appropriate analgesia with sufficient intraoperative remifentanil consumption, lower incidence of hypertension/ tachycardia events, and a lower incidence of delirium in the PACU than the conventional analgesia. However, SPI-guided analgesia may not prevent perioperative immune system deterioration.Trial registrationThe randomized controlled trial was retrospectively registered in the UMIN Clinical Trials Registry (trial number: UMIN000048351; date of registration: 12/07/2022).

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

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Fig. 1