kg −1) in patients who were kg −1, 0.5 mg maximal dose) and sodium thiopental (5 mg.Anaesthesia was induced with atropine (0.02 mg Each patient was transported to the operating room and monitored by electrocardiograph (ECG), non-invasive blood pressure, pulse oximeter (SpO 2) on the finger, end-tidal carbon dioxide (E TCO 2) with patient monitor (Solar 8000 GE Medical, Milwaukee, WI, USA), and Bispectral Index™ (BIS Covidien, Mansfield, MA, USA). The patients were appropriately hydrated with intravenous Ringer’s lactate solution, according to Holliday-Segar guideline this was confirmed by acceptable initial vital signs, which were compared with ward values. An equal number of patients were assigned to each group.ĬONSORT diagram showing flow of patients through the various stages of the studyĮach patient was fasted per preoperative fasting guidelines and arrived at the operating theatre without premedication. −1 of sufentanil administration, group H. −1 of sufentanil administration, group M 0.8 μg −1 of sufentanil administration, group L 0.5 μg Patients were randomly assigned to three groups prior to surgery ( ) (Fig. Exclusion criteria included known peripheral vascular disease, cardiovascular disease, respiratory disease, increased intracranial pressure or an allergy to opioids. All surgeries included cranial pinning prior to the neurosurgical procedure. This study was approved by the institutional review board of Seoul National University Hospital (H-1310-044-526, Seoul, Korea) and registered at .kr (KCT0000978, Jan-07, 2014).Īfter obtaining informed consent from parents or guardians of children who were scheduled for elective neurosurgery under general anaesthesia, we enrolled 51 children (2–12 years of age) who had a physical status of 2 or 3, per guidelines from the American Society of Anesthesiologists. In this study, we investigated the effect of different infusion rates of sufentanil on SSI, which is a known method for intraoperative nociceptive monitoring, during cranial pinning in children under general anaesthesia. However, BP and HR may not be appropriate reference measurements because they might be affected by stimuli other than the balance between nociception and anti-nociception, such as volume state or use of vasopressors. Additionally, sufentanil is an opioid that is commonly used to blunt the noxious stimulus during neurosurgical anaesthesia its infusion rate is typically adjusted according to blood pressure (BP) or heart rate (HR). Pinning for head fixation (also known as cranial pinning) during neurosurgery is a very short and strong stimulus the responses to cranial pinning under insufficient analgesia might include hypertension, tachycardia, increased intracranial pressure, or disturbance of cerebral perfusion. Among the measurements listed above, SSI based on photoplethysmogram (PPG) may best facilitate monitoring of nociception during anaesthesia because all patients are monitored by PPG during anaesthesia using standard devices that are present in a wide range of clinical settings. However, as most of these measurements require specific monitoring devices, they may be impossible to implement without the aid of specific devices that are not available in every clinical setting.
93.1 DA PAINA SONG HISTORY SKIN
Recently, a variety of methods have been suggested to monitor nociception during anaesthesia: pupillometry, surgical pleth index (SPI), surgical stress index (SSI), skin conductance, analgesia/nociception index, cardiovascular depth of analgesia index, wavelet transform cardiorespiratory coherence, photoplethysmogram amplitude (PPGA), and nociception level index. However, the reliability of these responses may vary because of potential confounders. Traditionally, autonomic responses, such as tachycardia, hypertension, or sweating, have been used to assess nociception during general anaesthesia. Therefore, maintenance of the balance between nociception and antinociception is important during anaesthesia. Importantly, insufficient management of the nociceptive response can affect postoperative outcomes. Nonetheless, patients can respond to surgical stimuli this response appears to be blunted by the administration of anaesthesia. However, patients cannot express a conscious sense of surgical pain during general anaesthesia.
Pain is a term that describes an emotional and personal experience.
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