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Assessment of stress response due to C-Mac D-blade guided videolaryngoscopic endotracheal intubation and docking of da Vinci surgical robot using perfusion index in patients undergoing transoral robotic oncosurgery

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Abstract

Clinical utility of perfusion index (PI) has entered a new realm as a non-invasive, quantitative index of stress response to endotracheal intubation. Transoral robotic surgery (TORS) involves F-K retractor aided docking of the surgical robot producing haemodynamic and stress responses akin to laryngoscopy. We compared the stress response to videolaryngoscopy with that due to docking of da Vinci surgical robot using PI, heart rate and mean arterial pressure evaluated at specific time points post-laryngoscopy and post-docking. Twenty-six adult patients, scheduled for TORS under general endotracheal anaesthesia were included in this prospective, observational, single-centric cohort study. Statistical analysis included paired samples t-test, dotted box-whisker plots, trendlines and correlograms for comparative analysis of two stressors, laryngoscopy and docking. Baseline PI was 4.14. PI values increased post-midazolam (4.23), 1 min (5.69) and 3 min (6.25) post anaesthetic-induction, plummeted at laryngoscopy (3.24), remained low at 1 min (3.68), 3 min (4.69) thereafter, and were highest at 10 min (6.17) post-laryngoscopy and predocking (6.84). Docking witnessed a fall in PI (4.1), which remained low at 1 min (4.02), 3 min (4.31) and 10 min (4.79) post-docking. PI was significantly higher at laryngoscopy compared with PI at docking (p = 0.0044). At 1 min and 3 min post-laryngoscopy and post-docking, respectively, the differences in PI were statistically insignificant. PI at 10 min post-laryngoscopy was significantly lower than PI at 10 min post-docking (p < 0.0001). As non-invasively quantified by PI, videolaryngoscopic stress response is more intense but shorter-lived versus that due to docking. PI displays a negative correlation with haemodynamic variables. PI at laryngoscopy is a good predictor of PI at docking, enabling pre-emptive measures (fentanyl bolus; deepening of volatile anaesthesia from MAC-maintenance to MAC-intubation) anticipating the docking-induced stress response.

Trial registration http://ctri.nic.in; Identifier: CTRI/2019/11/022091.

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Acknowledgements

Assistance with the study: We would like to thank Dr. AK Bhargava, Dr. AK Dewan and Dr. Mudit Aggarwal for their assistance and encouragement in conduct of this study.

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The authors declare that no funds, grants, or other financial support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Anaesthesia and Critical Care, Rajiv Gandhi Cancer Institute and Research Centre, Sec-5; Rohini, Delhi, 110085, India

    Shagun Bhatia Shah, Rajiv Chawla & Charanjeet Kaur

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  1. Shagun Bhatia Shah
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  2. Rajiv Chawla
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  3. Charanjeet Kaur
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by [SBS], [RC] and [CK]. The first draft of the manuscript was written by [SBS] and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Shagun Bhatia Shah.

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Conflicts of interest

The authors have no relevant financial or non-financial interests to disclose.

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None declared.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India (Date 4 February 2019/No RGCIRC/IRB/255/2018; Chairperson Dr. A Rao).

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Informed consent was obtained from all individual participants included in the study.

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Appendix

Appendix

See Tables 3, 4, 5, 6, 7.

Table 3 Summary statistics for perfusion index (BaseM = Baseline post-midazolam; D = Docking; I = Induction; L = Laryngoscopy; N = Sample size; PI = Perfusion Index; PreDock = Just before docking)
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Table 4 Summary statistics table for heart rate
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Table 5 Summary statistics table for mean arterial pressure (MAP)
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Table 6 Correlation table (Including the patient with bradycardia)
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Table 7 Correlation table (Data of the patient with bradycardia (outlier) excluded from DifHRL and DifHRD)
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Shah, S.B., Chawla, R. & Kaur, C. Assessment of stress response due to C-Mac D-blade guided videolaryngoscopic endotracheal intubation and docking of da Vinci surgical robot using perfusion index in patients undergoing transoral robotic oncosurgery. J Clin Monit Comput 37, 1011–1021 (2023). https://doi.org/10.1007/s10877-023-01005-5

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