Comparison of the effect of different infusion rates of sufentanil on surgical stress index during cranial pinning in children under general anaesthesia: a randomized controlled study

Abstract

BackgroundSurgical stress index (SSI) is an established indicator for intraoperative nociception. Opioids are used to block stimulus of cranial pinning in neurosurgery. We investigated the effect of different infusion rates of sufentanil on SSI during cranial pinning in children under general anaesthesia.MethodsForty-nine children (2–12 years of age) underwent neurosurgery with pinning. The children were randomized into three groups based on the rate of sufentanil infusion: 0.2, 0.5, and 0.8 μg·kg−1·hr.−1. Continuous sufentanil infusion began following neuromuscular blockade administration, at a rate determined by each patient’s assigned treatment group. Following preparation for surgery, cranial pinning was performed. Systolic, diastolic, and mean blood pressures, along with heart rate and photoplethysmographic data, were continuously recorded from 1 min prior to cranial pinning through 5 min after cranial pinning, in 1-min intervals. SSI was calculated following the completion of surgery. Differences in measured outcomes over time among the three groups were evaluated using a generalized estimation equation. Differences in pinning outcomes in the same group were evaluated with Freidman test.ResultsWe found no statistical differences in long-term SSI that were associated with different infusion rates of sufentanil during cranial pinning. Blood pressures in all groups increased for 2 min after cranial pinning, and then decreased; we found no statistical difference in long-term blood pressure values among the groups. Heart rate increased after pinning in the group that received a low-dose infusion of sufentanil.ConclusionsSince SSI was intended to measure the blunting effects of sufentanil towards the noxious stimulus of cranial pinning, our results suggest that SSI might not be sufficiently sensitive to monitor the nociceptive response in children.Trial registration(KCT0000978, Jan-07, 2014).

<p>Effects of Additional Intraoperative Administration of Sufentanil on Postoperative Pain, Stress and Inflammatory Responses in Patients Undergoing Laparoscopic Myomectomy: A Double-Blind, Randomized, Placebo-Controlled Trial</p>

“…Sufentanil takes nearly 45 minutes to achieve a steadystate between plasma concentrations and effect-site concentrations, so we chose to administrate sufentanil 1h before the end of the surgery (usually when the last myomas was begin to be removed) 23,24 Patients were sent to the operation room without any premedication, then the left lower limb peripheral veins were opened and compound sodium lactate solution 4-6 mL/kg/h was infused. Standard monitoring, including five-lead electrocardiography (ECG), pulse oxygen saturation (SpO 2 ), and noninvasive blood pressure (NBP), was performed.…”

“…After allocation, both patients and investigators were blinded to the interventions. Sufentanil takes nearly 45 minutes to achieve a steady-state between plasma concentrations and effect-site concentrations, so we chose to administrate sufentanil 1h before the end of the surgery (usually when the last myomas was begin to be removed) 23 , 24 …”

Monitoring of analgesia level during general anesthesia in children

“…In contrast, the ability of the SPI to provide not only detection but also a quantitative assessment of nociception in children is still debated. In 2–12 years old children, using different infusion rates of sufentanil during cranial pinning had no effect on SPI levels [23]. The administration of atropine as a systematic premedication, and the variety of anesthetic agents used during the procedure might limit the interpretation of these results.…”

Nociception monitoring tools using autonomic tone changes for intraoperative analgesic guidance in pediatric patients

“…In contrast, limitations have been reported for various clinical situations and confounding factors [ 18 – 23 ], one of which may be age. Thus, limitations presented in the studies of pediatric patients must be considered carefully [ 19 , 24 , 25 ].…”

“…Song et al [ 25 ] also reported there was no significant difference in SPI changes during cranial pin fixation among the groups received sufentanil infusion at three different rates (0.2, 0.5, and 0.8 μg/kg/h) in pediatric patients aged 2–12 years who underwent cranial pinning under general anesthesia, suggesting that SPI may not be sensitive enough to monitor a level of nociception and analgesia in children.…”