The effect of nicardipine on the surgical pleth index during thyroidectomy under general anesthesia: A prospective double-blind randomized controlled trial.
BACKGROUND
The effectiveness of surgical pleth index (SPI) for managing nociception-antinociception balance during general anesthesia with vasodilators, including nicardipine has not been demonstrated. We aimed to compare the time course during surgery in SPI values in patients receiving nicardipine or remifentanil infusion during thyroidectomy.


METHODS
Forty patients undergoing thyroidectomy were randomly assigned to receive nicardipine (group N; n = 19) or remifentanil (group R; n = 21) along with induction (propofol, fentanyl, and rocuronium) and maintenance (50% desflurane/nitrous oxide in oxygen) anesthesia (goal bispectral index [BIS] ∼50). The infusion of nicardipine or remifentanil was started before the 1st incision and adjusted to keep mean blood pressure (MBP) within ±20% of the preoperative value. SPI, BIS, end-tidal desflurane concentration (EtDes), MBP, and heart rate were recorded at 2.5 minute intervals from the 1st incision to the end of surgery. Extubation and recovery times, pain score/rescue ketorolac consumption, and adverse events in postanesthesia care unit (PACU) were recorded.


RESULTS
The trend of SPI during surgery was comparable between the 2 groups (P = 0.804), although the heart rates in group N were significantly higher than those in group R (P = 0.040). The patient characteristics, trends of BIS, EtDes, and MBP during surgery, extubation and recovery times, and incidence of nausea/vomiting were comparable between the groups. Group N had significantly lower pain scores and rescue ketorolac consumption at PACU.


CONCLUSIONS
SPI was comparable between patients receiving nicardipine or remifentanil infusion during thyroidectomy under general anesthesia, which suggests that the administration of nicardipine may confound the interpretation of SPI values during general anesthesia.


BACKGROUND
This trial was registered in the UMIN clinical trials registry (unique trial number: UMIN000019058; registration number: R000022028; principal investigator's name: Young Ju Won; date of registration: September 17, 2015).
Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
Young Ju
YJ
Won
Byung Gun
BG
Lim
Gwi Eun
GE
Yeo
Min Ki
MK
Lee
Dong Kyu
DK
Lee
Heezoo
H
Kim
Il Ok
IO
Lee
Myoung Hoon
MH
Kong
D000701:Analgesics, Opioid / Q000627:therapeutic use; D000768:Anesthesia, General / Q000379:methods; D004311:Double-Blind Method; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D008297:Male; D009529:Nicardipine / Q000494:pharmacology*; D010149:Postoperative Pain / Q000188:drug therapy*; D017156:Photoplethysmography / Q000187:drug effects*; D010880:Piperidines / Q000627:therapeutic use; D020250:Postoperative Nausea and Vomiting / Q000188:drug therapy; D011446:Prospective Studies; D000077208:Remifentanil; D013965:Thyroidectomy / Q000379:methods*; D014665:Vasodilator Agents / Q000494:pharmacology*
D000701:Analgesics, Opioid; D010880:Piperidines; D014665:Vasodilator Agents; D009529:Nicardipine; D000077208:Remifentanil