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Measurement of surgical stress in anaesthetized children
H Kallio1, L I Lindberg, A S Majander
1Department of Anaesthesiology and Intensive Care Medicine, Eye Hospital, Helsinki, Finland. helena.kallio@hus.fi
Insights
The surgical stress index (SSI) and other physiological markers effectively monitor intraoperative stress in anesthetized children undergoing strabismus surgery. These indicators reveal autonomic responses to painful stimuli during surgical procedures.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Physiology
Background:
- The surgical stress index (SSI), a novel method for continuous intraoperative stress monitoring, combines heart rate (HR) and photoplethysmographic amplitude (PPGA).
- While validated in adults, the applicability of SSI and its components for monitoring stress in pediatric patients remains unevaluated.
Purpose of the Study:
- To evaluate the efficacy of the surgical stress index (SSI) and its constituents in monitoring intraoperative stress in children.
- To assess the detection of autonomic responses to nociceptive stimuli in pediatric patients undergoing anesthesia.
Main Methods:
- A controlled trial involving 22 anesthetized children (aged 4-17 years) undergoing strabismus surgery.
- Patients were randomized into two groups: topical conjunctival anesthesia with lidocaine/levobupivacaine (Group LL) or balanced salt solution (Group BSS).
- Monitoring included SSI, photoplethysmographic amplitude (PPGA), heart rate (HR), non-invasive blood pressure (NIBP), and electroencephalography-derived entropy (RE-SE).
Main Results:
- Endotracheal intubation significantly increased SSI, decreased PPGA, and increased RE-SE, alongside conventional hemodynamic variables (HR, S-NIBP).
- During surgery, SSI showed a significant increase and PPGA a significant decrease compared to baseline in both groups.
- No significant differences in SSI or other indicators were observed between the lidocaine/levobupivacaine and balanced salt solution groups.
Conclusions:
- The surgical stress index (SSI), photoplethysmographic amplitude (PPGA), heart rate (HR), non-invasive blood pressure (NIBP), and entropy measures (RE, RE-SE) successfully detect autonomic responses to nociceptive stimuli.
- These findings support the use of SSI and related physiological parameters for continuous intraoperative stress monitoring in anesthetized children.
Background:
The surgical stress index (SSI), derived from a combination of heart rate (HR) and photoplethysmographic amplitude (PPGA) time series, is a novel method for continuous monitoring of intraoperative stress and has been validated in adults. The applicability of SSI and its constituents to monitoring children has not been previously evaluated.
Methods:
In this controlled trial, 22 anaesthetized patients, aged 4-17 yr, undergoing strabismus surgery were randomized into two groups, Group LL and Group BSS. Patients in Group LL received topical conjunctival anaesthesia with a 1:1 mixture of lidocaine 2% and levobupivacaine 0.75%, and patients in Group BSS received balanced salt solution.
Results:
Endotracheal intubation (n=22) increased median (range) SSI from 39.2 (22.6-55.6) to 53.6 (35.8-63.3) (P<0.001), decreased PPGA from 5.62 (2.79-9.69) to 5.27 (2.59-7.54)% (P=0.001), and increased the difference of response entropy (RE) and state entropy (SE) of frontal biopotentials (RE-SE) from 3.1 (0.06-9.1) to 5.7 (0.6-9.4) (P=0.01). Conventional haemodynamic variables also increased, median (range) HR from 72.9 (56.7-113.8) to 84.2 (60.4-124.8) beats min(-1) (P<0.001), and systolic non-invasive arterial pressure (S-NIBP) from 87 (78-143) to 103 (79-125) (P=0.007). When 3 min baseline before surgery was compared with 12 min of surgery, median (range) SSI increased from 43.3 (31.2-58.0) to 49.9 (39.3-57.2) (P=0.042) vs from 46.6 (26.8-57.8) to 52.1 (31.7-60.1) (P=0.024) and PPGA decreased from 6.60 (3.10-8.24) to 5.80 (3.03-7.65)% (P<0.001) vs from 5.51 (3.25-9.84) to 5.06 (3.08-8.99)% (P=0.042), in Groups LL and BSS, respectively, but SSI or other indicators did not differ significantly between the groups.
Conclusions:
SSI, PPGA, HR, NIBP, RE, and RE-SE detect autonomic responses to nociceptive stimuli in anaesthetized children undergoing strabismus surgery.
