Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Anesthesiology
Published in: BMC Anesthesiology 1/2017

Open Access 01-12-2017 | Research article

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

Authors: In-Kyung Song, Sang-Hwan Ji, Eun-Hee Kim, Ji-Hyun Lee, Jin-Tae Kim, Hee-Soo Kim

Published in: BMC Anesthesiology | Issue 1/2017

Login to get access

Abstract

Background

Surgical 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.

Methods

Forty-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.

Results

We 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.

Conclusions

Since 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).
Literature
1.
Salo M. Effects of anaesthesia and surgery on the immune response. Acta Anaesthesiol Scand. 1992;36(3):201–20.CrossRefPubMed
2.
Crozier TA, Muller JE, Quittkat D, Sydow M, Wuttke W, Kettler D. Effect of anaesthesia on the cytokine responses to abdominal surgery. Br J Anaesth. 1994;72(3):280–5.CrossRefPubMed
3.
Corsi M, Mariconti P, Calvillo L, Falchi M, Tiengo M, Ferrero ME. Influence of inhalational, neuroleptic and local anaesthesia on lymphocyte subset distribution. Int J Tissue React. 1995;17(5-6):211–7.PubMed
4.
Vallejo R, Hord ED, Barna SA, Santiago-Palma J, Ahmed S. Perioperative immunosuppression in cancer patients. J Environ Pathol Toxicol Oncol. 2003;22(2):139–46.CrossRefPubMed
5.
6.
Hoymork SC. Antinociceptive monitors: tools or fools? Acta Anaesthesiol Scand. 2008;52(8):1035–7.CrossRefPubMed
7.
Larson MD, Sessler DI, Washington DE, Merrifield BR, Hynson JA, McGuire J. Pupillary response to noxious stimulation during isoflurane and propofol anesthesia. Anesth Analg. 1993;76(5):1072–8.CrossRefPubMed
8.
Struys MM, Vanpeteghem C, Huiku M, Uutela K, Blyaert NB, Mortier EP. Changes in a surgical stress index in response to standardized pain stimuli during propofol-remifentanil infusion. Br J Anaesth. 2007;99(3):359–67.CrossRefPubMed
9.
Wennervirta J, Hynynen M, Koivusalo AM, Uutela K, Huiku M, Vakkuri A. Surgical stress index as a measure of nociception/antinociception balance during general anesthesia. Acta Anaesthesiol Scand. 2008;52(8):1038–45.CrossRefPubMed
10.
Storm H, Myre K, Rostrup M, Stokland O, Lien MD, Raeder JC. Skin conductance correlates with perioperative stress. Acta Anaesthesiol Scand. 2002;46(7):887–95.CrossRefPubMed
11.
Jeanne M, Clement C, De Jonckheere J, Logier R, Tavernier B. Variations of the analgesia nociception index during general anaesthesia for laparoscopic abdominal surgery. J Clin Monit Comput. 2012;26(4):289–94.CrossRefPubMed
12.
Martinez JY, Wey PF, Lions C, Cividjian A, Rabilloud M, Bissery A, Bourdon L, Puidupin M, Escarment J, Quintin L. A beat-by-beat cardiovascular index, CARDEAN: a prospective randomized assessment of its utility for the reduction of movement during colonoscopy. Anesth Analg. 2010;110(3):765–72.CrossRefPubMed
13.
Brouse CJ, Karlen W, Myers D, Cooke E, Stinson J, Lim J, Dumont GA, Ansermino JM. Wavelet transform cardiorespiratory coherence detects patient movement during general anesthesia. Conf Proc IEEE Eng Med Biol Soc. 2011;2011:6114–7.PubMed
14.
Wang X, Chen X, Ye S, Feng Y, Huang C, Hou L, Liu J, Chen H. Changes in the photoplethysmogram with tracheal intubation and remifentanil concentration. Anaesthesia. 2012;67(12):1332–6.CrossRefPubMed
15.
Edry R, Recea V, Dikust Y, Sessler DI. Preliminary Intraoperative validation of the Nociception level index: a noninvasive Nociception monitor. Anesthesiology. 2016;125(1):193–203.CrossRefPubMed
16.
Pinosky ML, Fishman RL, Reeves ST, Harvey SC, Patel S, Palesch Y, Dorman BH. The effect of bupivacaine skull block on the hemodynamic response to craniotomy. Anesth Analg. 1996;83(6):1256–61.CrossRefPubMed
17.
Holliday MA, Segar WE. The maintenance need for water in parenteral fluid therapy. Pediatrics. 1957;19(5):823–32.PubMed
18.
Huiku M, Uutela K, van Gils M, Korhonen I, Kymalainen M, Merilainen P, Paloheimo M, Rantanen M, Takala P, Viertio-Oja H, et al. Assessment of surgical stress during general anaesthesia. Br J Anaesth. 2007;98(4):447–55.CrossRefPubMed
19.
Kallio H, Lindberg LI, Majander AS, Uutela KH, Niskanen ML, Paloheimo MP. Measurement of surgical stress in anaesthetized children. Br J Anaesth. 2008;101(3):383–9.CrossRefPubMed
20.
Choi BH, Lee YC. Effective bolus dose of Sufentanil to attenuate cardiovascular responses in Laryngoscopic double-lumen Endobronchial intubation. Anesth Pain Med. 2016;6(2):e33640.PubMedPubMedCentral
21.
Paloheimo MP, Sahanne S, Uutela KH. Autonomic nervous system state: the effect of general anaesthesia and bilateral tonsillectomy after unilateral infiltration of lidocaine. Br J Anaesth. 2010;104(5):587–95.CrossRefPubMed
22.
Song IK, Lee JH, Jung S, Kim JT, Kim HS. Estimation of the plasma effect site equilibration rate constant of sufentanil in children using the time to peak effect of heart rate and blood pressure. Indian J Pharmacol. 2015;47(4):360–4.CrossRefPubMedPubMedCentral
23.
Bergmann I, Szabanowski T, Brauer A, Crozier TA, Bauer M, Hinz JM. Remifentanil added to sufentanil-sevoflurane anesthesia suppresses hemodynamic and metabolic stress responses to intense surgical stimuli more effectively than high-dose sufentanil-sevoflurane alone. BMC Anesthesiol. 2015;15:3.CrossRefPubMedPubMedCentral
24.
Chen X, Thee C, Gruenewald M, Ilies C, Hocker J, Hanss R, Steinfath M, Bein B. Correlation of surgical pleth index with stress hormones during propofol-remifentanil anaesthesia. ScientificWorldJournal. 2012;2012:879158.PubMedPubMedCentral
25.
Ilies C, Ludwigs J, Gruenewald M, Thee C, Hanf J, Hanss R, Steinfath M, Bein B. The effect of posture and anaesthetic technique on the surgical pleth index. Anaesthesia. 2012;67(5):508–13.CrossRefPubMed
26.
Guay J, Gaudreault P, Tang A, Goulet B, Varin F. Pharmacokinetics of sufentanil in normal children. Can J Anaesth. 1992;39(1):14–20.CrossRefPubMed
Metadata
Title
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
Authors
In-Kyung Song
Sang-Hwan Ji
Eun-Hee Kim
Ji-Hyun Lee
Jin-Tae Kim
Hee-Soo Kim
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2017
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/s12871-017-0448-6

Other articles of this Issue 1/2017

BMC Anesthesiology 1/2017 Go to the issue

Research article

Bougies as an aid for endotracheal intubation with the Airway Scope: bench and manikin comparison studies

Research article

A single dose of dezocine suppresses emergence agitation in preschool children anesthetized with sevoflurane-remifentanil

Research article

Validation of the imperial college surgical assessment device for spinal anesthesia

Research article

Minimal shedding of the glycocalyx layer during abdominal hysterectomy

Research article

Incidence and risk factors of chronic pain following hysterectomy among Southern Jiangsu Chinese Women

Research article

Normal gastric emptying time of a carbohydrate-rich drink in elderly patients with acute hip fracture: a pilot study