Surgical pleth index: prediction of postoperative pain in children?

Ledowski, Thomas; Sommerfield, David; Slevin, Lliana; Conrad, John; Ungern‐Sternberg, Britta S. von

doi:10.1093/bja/aex300

Cited by 41 publications

(35 citation statements)

References 10 publications

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“…In fact, a recent own investigation of the predictive value of SPI in different aged children concluded that SPI performed differently across the age groups. 14 Though all aforementioned results show significant limitations in the value of SPI for the prediction of postoperative pain, it is worth keeping in mind that we also confirmed the even lower value of MAP and HR for this task, with these parameters being as predictive for postoperative pain as tossing a coin. Similar results have been reported previously.…”

Section: Discussionsupporting

confidence: 67%

Surgical pleth index: prospective validation of the score to predict moderate-to-severe postoperative pain

Ledowski

Schneider

Gruenewald

et al. 2019

British Journal of Anaesthesia

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Background: Reported outcome benefits after surgical pleth index (SPI, GE Healthcare, Helsinki, Finland) guided anaesthesia are conflicting. One potential explanation may be the lack of evidence for the selection of meaningful SPI target values. A recently published trial found an SPI cut-off of 30 as a 'best-fit' to predict moderate-to-severe acute postoperative pain. This prospective trial was designed to validate this target and to investigate the influence of patient age on SPI in this context. Methods: After ethics approval, 200 patients undergoing non-emergency surgery were enrolled. Data related to SPI, heart rate (HR), and mean arterial pressure (MAP) were recorded for the last 5 min of surgery, just before arousal. After admission to recovery, pain scores (numeric rating scale [NRS], 0e10) were obtained every 5 min for 15 min. Results: The data of 196 patients were analysed. Receiver-operating curve analysis showed a cut-off SPI value of 29 to be the optimum intraoperative target to discriminate between NRS 0e3 and 4e10. This confirms the 'best fit' cut-off for SPI published previously. Though still superior to HR and MAP, the sensitivity and specificity of the SPI were only poor. Age had no influence on the predictive accuracy of SPI. Conclusions: An SPI of approximately 30 was confirmed as having the best sensitivity/specificity to predict moderate-tosevere pain in the postanaesthesia care unit. However, the predictive accuracy was overall poor and not influenced by patient age. Clinical trial registration: ACTRN12617001475336.

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Section: Discussionsupporting

confidence: 67%

Surgical pleth index: prospective validation of the score to predict moderate-to-severe postoperative pain

Ledowski

Schneider

Gruenewald

et al. 2019

British Journal of Anaesthesia

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“…SPI values, which indicate surgical stress reactions, range between 0 and 100, with 0 representing the lowest stimulus response and 100 representing the highest level of stimulation. High SPI values are considered indicators of a prevalence of nociception over antinociception [7]. Surgical procedures under general anesthesia elicit a variety of stress responses that induce negative influences and that eventually negatively affect patients' prognosis [22,23].…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, SPI can estimate intraoperative nociception. SPI ranges from 0 to 100, and higher values indicate stronger stimuli during surgery [7].…”

Section: Introductionmentioning

confidence: 99%

Effect of dexmedetomidine on intraoperative Surgical Pleth Index in patients undergoing video-assisted thoracoscopic lung lobectomy

Wang

Kong

2020

J Cardiothorac Surg

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Background The Surgical Pleth Index (SPI) is a monitoring method that reflects painful stimuli during general anesthesia, and dexmedetomidine is an analgesic adjuvant with an opioid-sparing effect. But up to now, it is still unclear whether dexmedetomidine has any influence on SPI. To investigate whether dexmedetomidine has an effect on SPI during video-assisted thoracoscopic surgery. Methods We enrolled 94 patients who underwent video-assisted thoracoscopic lung lobectomy. Patients were randomly assigned to a dexmedetomidine group (dexmedetomidine: 0.8 μg/kg administered for 10 min before anesthesia) or normal saline group (equal volume of normal saline). SPI and vital signs were recorded. The number rating scale (NRS) pain score was also evaluated. Results SPI values were significantly lower in the dexmedetomidine group than in the normal saline group at intubation and at discharge from the postanesthesia care unit. Compared with the normal saline group, mean arterial pressure and heart rate were both significantly lower in the dexmedetomidine group at intubation. Heart rate was lower at skin incision in the dexmedetomidine group. The NRS score in the normal saline group was noticeably higher vs. the dexmedetomidine group at discharge from the postanesthesia care unit. Conclusions Dexmedetomidine decreased intraoperative SPI and NRS scores. Our results showed that dexmedetomidine attenuated noxious stimuli. Trial registration Chinese Clinical Trial Registry (ChiCTR): ChiCTR-OOC-16009450, Registered 16 October, 2016.

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“…However, the evidence for this recommendation is relatively sparse. Two studies have postulated that the 'ideal' SPI may be significantly influenced by age (children vs adults), 62 and that it could be possibly lower (i.e. at or below 30).…”

Section: Two-parameter Scoresmentioning

confidence: 99%

Objective monitoring of nociception: a review of current commercial solutions

Ledowski

2019

British Journal of Anaesthesia

182

141

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Nociception, in contrast to pain, is not a subjective feeling, but the physiological encoding and processing of nociceptive stimuli. However, monitoring nociception remains a challenge in attempts to lower the incidence of acute postoperative pain and the move towards a more automated approach to analgesia and anaesthesia. To date, several commercialised devices promise a more accurate reflection of nociception than the traditionally used vital signs, blood pressure and heart rate. This narrative review presents an overview of existing technologies and commercially available devices, and offers a perspective for future research. Although firm conclusions about individual methods may be premature, none currently appears to offer a sufficiently broad applicability. Furthermore, there is currently no firm evidence for any clinically relevant influence of such devices on patient outcome. However, the available monitors have significantly aided the understanding of underlying mechanisms and identification of potential pitfalls.

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Surgical pleth index: prediction of postoperative pain in children?

Abstract: ACTRN12616001139460.

Cited by 41 publications

References 10 publications

Surgical pleth index: prospective validation of the score to predict moderate-to-severe postoperative pain

Surgical pleth index: prospective validation of the score to predict moderate-to-severe postoperative pain

Effect of dexmedetomidine on intraoperative Surgical Pleth Index in patients undergoing video-assisted thoracoscopic lung lobectomy

Objective monitoring of nociception: a review of current commercial solutions

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