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Two different methods to assess sympathetic tone during general anesthesia lead to different findings

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Abstract

Noxious stimulation influences the autonomic nervous system activity. Sympathetic tone monitoring is currently used to assess the adequacy of the balance between nociception and anti-nociception during general anesthesia. The Surgical Plethysmographic Index (SPI) and the EBMi software (Custos©) are commercial devices that use different algorithms to measure it. We aimed at determining whether those devices provide similar information during routine surgical procedures under general anesthesia. Data acquired during a previously published study in patients undergoing surgery under general anesthesia were retrospectively analyzed and passed through the EBMi software. The occurrence of EBMi alarms of increased sympathetic tone was compared to the occurrence of SPI values ≥ 60, a commonly recommended intraoperative SPI threshold. Trends in classical parameters of sympathetic tone during the 5 min preceding a SPI ≥ 60, namely blood pressure, heart rate, and plethysmographic pulse amplitude were assessed. SPI ≥ 60 episodes (n = 307) were more frequent than EBMi alerts (n = 240). Approximately 70% of EBMi alerts occurred during periods where the SPI was below 60. Among all episodes of SPI ≥ 60, absence of any EBMi alerts was much more frequent than the inverse. A majority, but not all SPI ≥ 60 episodes were consistently preceded by an increase in heart rate and/or a decrease in pulse amplitude. Blood pressure did not significantly change before SPI ≥ 60. Longer SPI ≥ 60 episodes were associated with lower anti-nociception anesthetic regimen. Different methods of sympathetic tone assessment during general anesthesia provide conflicting information. Prospective studies should be undertaken to clarify the clinical indications of both techniques.

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Acknowledgements

This study was supported by the Department of Anaesthesia and ICM, Liege University Hospital, Liege, Belgium, by the University Department of Anaesthesia and ICM, CHR Citadelle, Liege, Belgium, and by the Department of Anesthesiology, Erasme University Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium. The authors want to warmly thank Kimmo Uutela from GE Healthcare Finland Oy (Helsinki, Finland) for help in data extraction.

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Author notes

  1. Aline Defresne, Michael Harrison, Luc Barvais and Vincent Bonhomme have contributed equally to the present manuscript.

Authors and Affiliations

  1. GIGA – Consciousness, Anesthesia and Intensive Care Medicine Laboratory, University and CHU University Hospital of Liege, Liege, Belgium

    Aline Defresne & Vincent Bonhomme

  2. Department of Anaesthesia and Intensive Care Medicine, CHU University Hospital of Liege, Liege, Belgium

    Aline Defresne & Vincent Bonhomme

  3. University Department of Anaesthesia and Intensive Care Medicine, CHR Citadelle, Bd du 12eme de Ligne, 1, Liege, 4000, Belgium

    Aline Defresne & Vincent Bonhomme

  4. Department of Surgery and Anaesthesia, University of Otago, Wellington, New Zealand

    Michael Harrison

  5. Department of Anesthesiology, Erasme University Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium

    François Clement & Luc Barvais

Authors
  1. Aline Defresne
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  2. Michael Harrison
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  3. François Clement
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  4. Luc Barvais
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  5. Vincent Bonhomme
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Corresponding author

Correspondence to Vincent Bonhomme.

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Conflict of interest

Michael Harrison is one of the designers of the EBMi software. The other authors declare that they have no conflict of interest.

Ethical approval

All procedures performed on human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study is a retrospective analysis of data acquired during a previously published study, for which Ethics Committee approval was obtained. The initial study was registered at Clinicaltrials.gov, NCT: 02884310; https://clinicaltrials.gov/ct2/show/NCT02884310. Although formal consent is not required for retrospective studies, informed consent was obtained from all individual participants included in the study.

Additional information

An abstract related to this work has been submitted to the ANZCA ASM 2018 (https://asm.anzca.edu.au/) for possible presentation, and its evaluation is still under progress.

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Defresne, A., Harrison, M., Clement, F. et al. Two different methods to assess sympathetic tone during general anesthesia lead to different findings. J Clin Monit Comput 33, 463–469 (2019). https://doi.org/10.1007/s10877-018-0175-7

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  • DOI: https://doi.org/10.1007/s10877-018-0175-7

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