A beat-by-beat, on-line, cardiovascular index, CARDEAN, to assess circulatory responses to surgery: a randomized clinical trial during spine surgery.
Automated assessment of circulatory response to surgical stimuli is unsolved. Would detection of cardiac baroreflex inhibition assess adequacy of intra-operative anti-nociception upon incision, as performed on-line on a beat-by-beat basis by a cardiovascular index, CARDEAN™? 18 ASA I-II patients undergoing spinal disc repair were studied, in a prospective randomized single-blinded trial (observational study). During infusion of propofol to maintain bispectral index between 40 and 60, patients were allocated to receive an effect site target-controlled infusion of remifentanil at Ce = 2 or 4 ng ml(-1). Upon incision and during surgery, circulatory response was assessed using beat-by-beat measurements of minor hypertension and tachycardia to give a cardiovascular index, CARDEAN, scaled between 0 and 100. Upon skin incision, CARDEAN increased in the remifentanil Ce = 2 ng ml(-1) group (n = 7, P < 0.05), while it did not increase in the remifentanil Ce = 4 ng ml(-1) group (n = 7, P = 0.18). During surgery, retrospectively, CARDEAN > 60 was associated with tachycardia and hypertension (P (k) = 0.81 ± 0.10). Changes in CARDEAN appeared linked to adequacy of anti-nociception.
Department of Anesthesia, CHU Grenoble and University of Grenoble, Grenoble, France.
M
M
Rossi
A
A
Cividjian
M C
MC
Fevre
M E
ME
Oddoux
J
J
Carcey
C
C
Halle
M
M
Frost
M
M
Gardellin
J F
JF
Payen
L
L
Quintin
D000328:Adult; D000701:Analgesics, Opioid; D018686:Anesthetics, Intravenous; D017704:Baroreflex; D001794:Blood Pressure; D005260:Female; D006339:Heart Rate; D006439:Hemodynamics; D006801:Humans; D007403:Intervertebral Disc / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D059225:Nociception; D010880:Piperidines; D015742:Propofol; D000077208:Remifentanil; D016037:Single-Blind Method; D013610:Tachycardia / Q000175:diagnosis
D000701:Analgesics, Opioid; D018686:Anesthetics, Intravenous; D010880:Piperidines; D000077208:Remifentanil; D015742:Propofol