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European Journal of Anaesthesiology:
Abstracts and Programme: EUROANAESTHESIA 2011: The European Anaesthesiology Congress: Evidence-based Practice and Quality Improvement

Surgical Pleth Index (SPI) guidance vs. standard practice during sevoflurane‐sufentanil anaesthesia: A randomised controlled trial: 1AP6‐6

Willms, S.; Ilies, C.; Bein, B.; Gruenewald, M.

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University Hospital Schleswig Holstein, Department of Anaesthesiology and Intensive Care, Kiel, Germany

Background and Goal of Study: Surgical Pleth Index (SPI), derived by finger plethysmography, was introduced to detect nociceptive stimulation and is dependent on analgesic drug concentration [1, 2]. The use of SPI reduced the number of unwanted intraoperative events and opiod consumption during guidance of total intravenous anaesthesia by remifentanil‐propofol [3]. The impact of SPI guidance during a balanced anaesthesia setting using a volatile anaesthetic and intermittend opiod administration has not been studied. Therefore, the present prospective randomized controlled trial aimed to examine the impact of SPI guidance during a sevoflurane‐sufentanil regimen.

Materials and Methods: Eighty‐two patients of ASA physical status I and II, scheduled for either trauma surgery or gynaecological laparoscopic surgery were randomized into either SSI‐guided analgesia group (SPI group) or standard practice group (control group). In both groups anaesthesia was induced with propofol and maintained by sevoflurane to keep bispectral index values between 40‐50. SPI group patients received a sufentanil bolus (10μg) whenever SPI value was above 50 for more than 30 seconds, whereas in control group patients sufentanil was administered according to standard clinical practice (MAD > 90 mmHg, HR > 80/min, patient movement). Vital parameters, sufentanil consumption, number of unwanted intraoperative events and recovery times were recorded.

Results and Discussion: Sufentanil consumption did not significantly differ between groups (p=0.18) and was 5,84 ng/kg/min in the SPI group and 6,62 ng/kg/min in the control group. No significant difference in terms of hypotensive events (MAD < 65 mmHg, p=0.25), hypertensive events (MAD > 100 mmHg, p=0.13) and unwanted intraoperative events such as movement, coughing or unwanted spontaneous breathing (p=0.89) was recorded between groups. Recovery times (suture to extubation) were comparable with 6,6 min in the SPI group and 7,3 min in the control group (p=0.55).

Conclusion(s): SPI guided analgesia does not significantly improve haemodynamic stability, prevention of unwanted events or improve recovery times during a balanced anaesthesia regimen using sevoflurane and sufentanil.

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References:

[1] Wennervirta J, Hynynen M, et al. Acta Anaesthesiol Scand 2008; 52:1038-45

[2] Huiku M, Uutela K, et al. Br J Anaesth 2007; 98(4):447-55

[3] Chen X, Thee C, et al. Anesthesiology 2010; 112:1175-83

© 2011 European Society of Anaesthesiology

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