20 May 2018 : Clinical Research
Development of a Hemodynamic Model Using Routine Monitoring Parameters for Nociceptive Responses Evaluation During Surgery Under General AnesthesiaMunetaka Hirose1ACDEFG*, Yoshiko Kobayashi1BCDE, Shiro Nakamoto1BD, Ryusuke Ueki1BD, Nobutaka Kariya1BDE, Tsuneo Tatara1DE
Med Sci Monit 2018; 24: CLR3324-3331
BACKGROUND: Routine hemodynamic monitoring parameters under general anesthesia, such as heart rate (HR), systolic blood pressure (SBP), and perfusion index (PI), do not solely reflect intraoperative nociceptive levels. We developed a hemodynamic model combining these 3 parameters for nociceptive responses during general anesthesia, and evaluated nociceptive responses to surgical skin incision.
MATERIAL AND METHODS: We first retrospectively performed discriminant analysis using 3 values – HR, SBP, and PI – to assess response to skin incision during tympanoplasty, laparoscopic cholecystectomy, and open gastrectomy to determine if combined use of these parameters differentiates nociceptive levels among these 3 surgeries. Secondly, ordinal logistic regression analysis was applied using the 3 parameters to develop an equation representing nociceptive response during general anesthesia, and then evaluated its utility to discern nociceptive responses to skin incision.
RESULTS: We developed the following hemodynamic model as calculated nociceptive response= –1+2/(1+ exp(–0.01 HR –0.02 SBP +0.17 PI)), and prospectively determined that calculated nociceptive responses to small skin incision for laparoscopic surgery were significantly lower than responses to large skin incision for laparotomy.
CONCLUSIONS: Our hemodynamic model using HR, SBP, and PI likely reflects nociceptive levels at skin incision during general anesthesia, and quantitatively discerned the difference in nociceptive responses to skin incision between laparoscopy and laparotomy. This model could be applicable to assess either real-time nociceptive responses or averaged nociceptive responses throughout surgery without using special equipment.
Keywords: Laparoscopy, Laparotomy, Nociception, Stress, Physiological
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