title: Sufentanil administration guided by surgical pleth index vs standard practice during sevoflurane anaesthesia: a randomized controlled pilot study.
abstract: BACKGROUND
  Evaluation of analgesia and antinociception during anaesthesia is still a challenging issue and routinely based on indirect and non-specific signs such as movement, tachycardia, or lacrimation. Recently, the surgical pleth index (SPI) derived by finger plethysmography was introduced to detect nociceptive stimulation during anaesthesia. While SPI guidance reduced the number of unwanted events during total i.v. anaesthesia (TIVA), the impact of SPI during volatile-based anaesthesia with intermittent opioid administration has not yet been elucidated.
  
  
  METHODS
  Ninety-four patients were randomized into either SPI-guided analgesia or standard practice (Control). In both groups, anaesthesia was maintained with sevoflurane to keep bispectral index values between 40 and 60. In the SPI group, patients received a sufentanil bolus (10 μg) whenever SPI value increased above 50, whereas in the control group, sufentanil was administered according to standard clinical practice. The number of unwanted somatic events, haemodynamics, sufentanil consumption, and recovery times were recorded.
  
  
  RESULTS
  The incidence of intraoperative unwanted somatic events was comparable between the groups (P=0.89). No significant differences with respect to hypotensive or hypertensive events were found. The mean (95% confidence interval) sufentanil consumption was non-significantly (P=0.07) reduced in the SPI group, 0.64 (0.57-0.71) vs 0.78 (0.64-0.91) µg min(-1). Recovery times were comparable between the groups.
  
  
  CONCLUSIONS
  Sufentanil administration guided by SPI during sevoflurane anaesthesia is clinically feasible. In contrast to TIVA, it did not improve anaesthesia conduct with respect to unwanted somatic events, haemodynamic stability, sufentanil consumption, emergence time, or post-anaesthesia care unit care. Therefore, we conclude that anaesthesia regimen has an impact on beneficial effects by SPI guidance. Clinical trial registration NCT01525537. (Registered at Clinicaltrials.gov.).
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig Holstein Campus Kiel, Schwanenweg 21, D-24105 Kiel, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Gruenewald
authors.forename: S
authors.initials: S
authors.lastname: Willms
authors.forename: O
authors.initials: O
authors.lastname: Broch
authors.forename: M
authors.initials: M
authors.lastname: Kott
authors.forename: M
authors.initials: M
authors.lastname: Steinfath
authors.forename: B
authors.initials: B
authors.lastname: Bein
mesh_terms: D000328:Adult; D000762:Anesthesia Recovery Period; D018685:Anesthetics, Inhalation / Q000494:pharmacology*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D004569:Electroencephalography / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage*; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods* / Q000706:statistics & numerical data; D010865:Pilot Projects; D010991:Plethysmography / Q000379:methods; D011446:Prospective Studies; D000077149:Sevoflurane; D017409:Sufentanil / Q000494:pharmacology*
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D000077149:Sevoflurane; D017409:Sufentanil
keywords: anaesthesia, general; anaesthetics volatile, sevoflurane; analgesia; equipment and monitors