Journal of Clinical Monitoring and Computing

, Volume 29, Issue 5, pp 561–567 | Cite as

Effect of propofol and remifentanil on a somatosensory evoked potential indicator of pain perception intensity in volunteers

  • Ana Castro
  • Pedro Amorim
  • Catarina S. Nunes
  • Fernando Gomes de Almeida
Original Research

Abstract

Somatosensory evoked potentials (SEPs) have been linked to noxious activation and stimulus intensity. In this exploratory study we investigated the impact of anaesthetic drugs on SEPs and pain ratings, to assess their applicability as an objective measure of the nociception/anti-nociception balance. Following institutional approval and written informed consent, 10 healthy adult volunteers were enrolled (29.5 ± 9.1 years, 63.0 ± 8.9 kg and 171.4 ± 7.2). Median nerve electrical stimulation was adjusted according to volunteers’ sensitive, motor and painful thresholds (PT). Baseline SEPs were registered, and remifentanil and propofol administered using a stair scheme TCI. For each drug combination a 1.3×PT stimulus was administered, and volunteers evaluated pain intensity in a numerical rating scale (0–10). SEPs’ amplitudes and latencies were normalized by the baseline values, reducing volunteers’ intervariability. Stimulation currents varied between 6–52 mA (1.3×PT) and pain ratings between 0 and 9. Cortical SEPs latencies were decreased for higher stimulus intensities (P < 0.01), accompanied by increased pain ratings (P < 0.01). An individually adjusted/normalized ratio based on cortical SEPs amplitude and interpeak latency is proposed(\(R_{Norm}\)): \(R_{Norm}\) and NSR were significantly correlated in three out of nine subjects, and \(R_{Norm}\) and remifentanil Ce were significantly correlated in two (low number of evaluation points). \(R_{Norm}\) was shown to decrease with increasing doses of propofol and remifentanil (P < 0.05). The proposed metric was depressed by anaesthetics and reflected pain evaluations. Further research is necessary to increase the number of volunteers and drugs’ combination, to assess its applicability during surgically adequate anesthetic leves.

Keywords

Pain Nociception Monitoring Somatosensory evoked potentials (SEPs) TIVA 

References

  1. 1.
    Arendt-Nielsen L, Bjerring P. Reaction times to painless and painful CO2 and argon laser stimulation. Eur J Appl Physiol. 1988a;58(3):266–73.Google Scholar
  2. 2.
    Arendt-Nielsen L, Bjerring P. Sensory and pain threshold characteristics to laser stimuli. J Neurol Neurosurg Psychiatry. 1988b;51(1):35–42.CrossRefPubMedCentralPubMedGoogle Scholar
  3. 3.
    Barvais L, Engelman E, Eba JM, Coussaert E, Cantraine F, Kenny GN. Effect site concentrations of remifentanil and pupil response to noxious stimulation. Br J Anaesth. 2003;91(3):347–52.CrossRefPubMedGoogle Scholar
  4. 4.
    Bonhomme V, Llabres V, Dewandre PY, Brichant JF, Hans P. Combined use of bispectral indextm and a-linetm autorregressive indextm to assess anti-nociceptive component of balanced anaesthesia during lumbar arthodesis. Br J Anaesth. 2006;96(3):353–60.CrossRefPubMedGoogle Scholar
  5. 5.
    Borgeat A, Wilder-Smith OH, Suter PM. The nonhypnotic therapeutic applications of propofol. Anesthesiology. 1994;80(3):642–56.CrossRefPubMedGoogle Scholar
  6. 6.
    Bornhövd K, Quante M, Glauche V, Bromm B, Weiller C, Bchel C. Painful stimuli evoke different stimulus-response functions in the amygdala, prefrontal, insula and somatosensory cortex: a single-trial fmri study. Brain. 2002;125(6):1326–36.CrossRefPubMedGoogle Scholar
  7. 7.
    Brunton L, Parker K, Blumenthal D, Buxton I (eds). Goodman and gilman’s manual of pharmacology and therapeutics, 12th edn. McGraw Hill; 2008.Google Scholar
  8. 8.
    Chernik DA, Gillings D, Laine H, Hendler J, Silver JM, Davidson AB, Schwam EM, Siegel JL. Validity and reliability of the observer’s: Assessment of alertness/sedation scale: Study with intravenous midazolam. J Clin Psychopharmacol. 1990;10(4).Google Scholar
  9. 9.
    Crabb I, Thornton C, Konieczko KM, Chan A, Aquilina R, Frazer N, Dor CJ, Newton DE. Remifentanil reduces auditory and somatosensory evoked responses during isoflurane anaesthesia in a dose-dependent manner. Br J Anaesth. 1996;76(6):795–801.CrossRefPubMedGoogle Scholar
  10. 10.
    Fu ES, Zhang Y, Li Q, Morris RW, Levitt RC. Baseline differences in mechanical nociception: Genetic regulation. Anesthesiology p A505; 2010.Google Scholar
  11. 11.
    Gannong WF (ed). Review of Medical Physiology, 22nd edn. Lange Medical Books/McGraw-Hill; 2005.Google Scholar
  12. 12.
    Greenwald SD, Rosow C. Bis and emg variability increase before somatic responses during surgery. Anesthesiology. 2006;105:1027.Google Scholar
  13. 13.
    Gruenewald M, Meybohm P, Ilies C, Hcker J, Hanss R, Scholz J, Bein B. Influence of different remifentanil concentrations on the performance of the surgical stress index to detect a standardized painful stimulus during sevoflurane anaesthesia. Br J Anaesth. 2009;103(4):586–93.CrossRefPubMedGoogle Scholar
  14. 14.
    Kruger L (ed). Methods in pain research. CRC Press; 2001.Google Scholar
  15. 15.
    Kumar A, Bhattacharya A, Makhija N. Evoked potential monitoring in anaesthesia and analgesia. Anaesthesia. 2000;55(3):225–41.CrossRefPubMedGoogle Scholar
  16. 16.
    ller EAM, Spangsberg N, Arendt-Nielsen L, Schultz P, Kristensen MS, Bjerring P. Subhypnotic doses of thiopentone and propofol cause analgesia to experimentally induced acute pain. Br J Anaesth. 1991;66(2):185–8.CrossRefGoogle Scholar
  17. 17.
    Mashour GA. Neurophysiology and intraoperative nociception: new potentials? Anesthesiology. 2013;118:239–40.CrossRefPubMedGoogle Scholar
  18. 18.
    Melzack R, Torgerson WS. On the language of pain. Anesthesiology. 1971;34(1):50–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Miltner W, Jr, RJ, Braun C, Larbig W, Somatosensory event-related potentials to painful and non-painful stimuli: effects of attention. Pain. 1989;38(3):303–12.Google Scholar
  20. 20.
    Minto CF, Schnider TW, Shafer SL. Pharmacokinetics and pharmacodynamics of remifentanil. ii. model application. Anesthesiology. 1997;86:24–33.CrossRefPubMedGoogle Scholar
  21. 21.
    Ohara S, Crone NE, Weiss N, Treede RD, Lenz FA. Amplitudes of laser evoked potential recorded from primary somatosensory, parasylvian and medial frontal cortex are graded with stimulus intensity. Pain. 2004;110(1–2):318–28.CrossRefPubMedGoogle Scholar
  22. 22.
    Rantanen M, Yli-Hankala A, Gils MV, Yppril-Wolters H, Takala P, Huiku M, Kymlinen M, Seitsonen E, Korhonen I. Novel multiparameter approach for measurement of nociception at skin incision during general anaesthesia. Br J Anaesth. 2006;96(3):367–76.CrossRefPubMedGoogle Scholar
  23. 23.
    Rhoades RA, Bell DR (eds). Medical physiology principles for clinical medicine, 3rd edn. Lippincott Williams and Wilkins, 2009.Google Scholar
  24. 24.
    Schnider TW, Minto CF, Gambus PL, Andresen C, Goodale DB, Shafer SL, Youngs EJ. The influence of method of administration and covariates on the pharmacokinetics of propofol in adult volunteers. Anesthesiology. 1998;88:1170–82.CrossRefPubMedGoogle Scholar
  25. 25.
    Shaw FZ, Chen RF, Tsao HW, Yen CT. Comparison of touch- and laser heat-evoked cortical field potentials in conscious rats. Brain Res. 1999;824(2):183–96.CrossRefPubMedGoogle Scholar
  26. 26.
    Storm H. Changes in skin conductance as a tool to monitor nociceptive simulation and pain. Curr Opin Anaesthesiol. 2008;21(6):796–804.CrossRefPubMedGoogle Scholar
  27. 27.
    Thornton C, Sharpe RM. Evoked responses in anaesthesia. Br J Anaesth. 1998;81(5):771–81.CrossRefPubMedGoogle Scholar
  28. 28.
    Thornton C, Creagh-Barry P, Jordan C, Luff NP, Dor CJ, Henley M, Newton DE. Somatosensory and auditory evoked responses recorded simultaneously: differential effects of nitrous oxide and isoflurane. Br J Anaesth. 1992;68(5):508–14.CrossRefPubMedGoogle Scholar
  29. 29.
    Untergehrer G, Jordan D, Eyl S, Schneider G. Effects of propofol, sevoflurane, remifentanil, and (s)-ketamine in subanesthetic concentrations on visceral and somatosensory painevoked potentials. Anesthesiology. 2013;118:308–17.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Ana Castro
    • 1
    • 2
  • Pedro Amorim
    • 2
  • Catarina S. Nunes
    • 2
    • 3
  • Fernando Gomes de Almeida
    • 1
    • 2
  1. 1.Faculdade de Engenharia da Universidade do PortoPortoPortugal
  2. 2.Centro de Investigação Clínica em Anestesiologia, Serviço de AnestesiologiaHospital de Santo António, Centro Hospitalar do PortoPortoPortugal
  3. 3.DCeT - Departamento de Ciências e Tecnologia, Universidade AbertaDelegação do PortoPortoPortugal

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