THE USE OF SURGICAL PLETH INDEX DURING ENDOSCOPIC

ANALGO SEDATION PROCEDURES.

M. Bossolasco1,2, F. Olivero1,2, A. Manassero3, S. Palmisano3, G. Coletta3

1
Anestesia, Rianimazione e Terapia Intensiva, Azienda Ospedaliera S. Croce e
Carle, Cuneo, 2Scuola di Specializzazione in Anestesia, Rianimazione e Terapia
Intensiva, Università di Torino, Torino, 3S.S. Blocco Operatorio, Azienda
Ospedaliera S. Croce e Carle, Cuneo, Italy

Objective: To determine if the Surgical Pleth Index (SPI) monitorization could be used to
guide physicians to obtain an effective and safe level of the nociception-
antinociception balance for people undergoing sedation endoscopic procedures.
The applicability of SPI for monitoring analgo sedation procedures has not been
Design: previously evaluated.
Setting: Clinical RCT.
Patients: Operatory room of a country hospital.
Methods: Patients undergoing endoscopic painful procedures (colonscopy with multiple
biopsy).
We recruited 50 patients, each of them was randomly assigned to group A
(propofol alone; 25 patients) or B (propofol - remifentanil; 25 patients).
Randomization was made using GraphPad StatMate Version 2.00 (GraphPad
Software Inc, San Diego, CA. www.graphpad.com).
The group A sedation was obtained using a target-controlled, as effect-site,
propofol infusion (Schnider pharmacokinetic model). Group B received 1,5 ng/mL
as target-controlled remifentanil infusion(Minto pharmacokinetic model) beyond
the propofol target-controlled infusion (TCI). In both group the anaesthesiologist
Measurements: adjusted the propofol predicted concentration in order to obtain a SE entropy value
between 60 to 70.
Every 2 -3 minutes an observer recorded, in both groups, all vital signs, the SPI
score, level of sedation (with a modified Ramsay sedation scale and a reactivity
score). At the end of the procedure the observer recorded the surgeon and the
patient satisfaction, using a 1 to 5 scale where 1 represents "not at all satisfied" and
5 represents "extremely satisfied". All data were collected and stored into a
database and evaluated at the end of the study.
Results: Patients were mostly men (58%), had a mean age of 66 (43-88). Demographic
characteristics of both groups were sufficiently matched in age, gender, ASA
classification, weight, and body mass index.
The SPI was higher in patients receiving propofol alone [mean 85.20, CI (84.2-
86.2)] compared with patients receiving remifentanil in addition to propofol
infusion [mean 65.98, CI (65.1-66.8)]. A value of 100 corresponds to a high stress
level and a value of 0 to a low stress level; values near 50 corresponds to the mean
stress level.
More patients in the group A showed cough, hiccup and movement which
transiently interfered with the examination.
There were no clinically significant differences in hemodynamic or recovery
variables between the two groups. No apnoea was recorded; we had one bradypnea
in group B.
There were no statistically significant differences in patients and surgeon
satisfaction.
Conclusion: SPI seems to reflect the nociception-antinociception balance during analgo
sedation endoscopic procedures. Other studies should be done in order to evaluate
if SPI could be used, during this kind of procedures, to drive remifentanil infusion.

Contact:
Matteo Bossolasco
Email: matteo.bossolasco@gmail.com
Trainee in anesthesia & intensive care; University of Turin, Italy.