Surgical pleth index-guided remifentanil administration reduces remifentanil and propofol consumption and shortens recovery times in outpatient anaesthesia

• Published in: British journal of anaesthesia : BJA Vol. 110; no. 4; pp. 622 - 628
• Main Authors: Bergmann, I., Göhner, A., Crozier, T.A., Hesjedal, B., Wiese, C.H., Popov, A.F., Bauer, M., Hinz, J.M.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-04-2013; Oxford University Press
• Subjects: Adolescent; Adult; Aged; Ambulatory Surgical Procedures; anaesthesia, depth; Anesthesia Recovery Period; Anesthesia, General; Anesthesia, Intravenous - methods; Anesthetics, Intravenous - administration & dosage; Arterial Pressure - drug effects; Arthroscopy; EEG; Entropy; Female; Heart Rate - drug effects; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Monitoring, Intraoperative - methods; Piperidines - administration & dosage; Plethysmography - methods; Postoperative Complications - epidemiology; Postoperative Nausea and Vomiting - epidemiology; Propofol - administration & dosage; SPI/surgical pleth index; stress; surgery, day-case; Survival Analysis; sympathetic nervous system; Young Adult; surgery, day-case; stress; SPI/surgical pleth index; anaesthesia, depth; EEG; sympathetic nervous system; SPI/surgical pleth index; stress; surgery, day-case
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1093/bja/aes426

The surgical pleth index (SPI) is an index based on changes in plethysmographic characteristics that correlate with the balance between the sympathetic and parasympathetic nervous system. It has been proposed as a measure of the balance between nociception and anti-nociception. The goal of this study was to test whether it could be used to titrate remifentanil in day-case anaesthesia.
A total of 170 outpatients were given total i.v. anaesthesia with propofol and remifentanil. The patients were randomized to have the remifentanil dose either adjusted according to the SPI (SPI group) or to clinical parameters (control group). The propofol dose was adjusted according to entropy in both groups. The consumption of anaesthetic drugs, recovery times, and complications were compared.
The mean [standard deviation (sd)] remifentanil and propofol infusion rates in the SPI and control groups were 0.06 (0.04) vs 0.08 (0.05) µg kg−1 min−1 and 6.0 (2.1) vs 7.5 (2.2) mg kg−1 h−1, respectively (both P<0.05). The mean (sd) times to eye opening were −0.08 (4.4) and 3.5 (4.3) min and to extubation were 1.2 (4.4) and 4.4 (4.5) min in the SPI and control groups, respectively (both P<0.05). There was no difference between the groups with regard to satisfaction with the anaesthetic or intensity of postoperative pain. No patient reported intraoperative awareness.
Adjusting the remifentanil dosage according to the SPI in outpatient anaesthesia reduced the consumption of both remifentanil and propofol and resulted in faster recovery.