Can Changes in Skin Impedance Be Used to Monitor Sedation After Midazolam and During Recovery from Anesthesia?

Overview

Journal Physiol Res

Specialty Physiology

Date 2021 Mar 7

PMID 33676384

Authors

A Kurzova

L Hess

J Sliva

J Malek

Affiliations

Soon will be listed here.

Abstract

It has been suggested that sympathetic activity, measured as changes in electrical skin impedance (SI), can be used to assess the adequacy of general anesthesia. Our prospective study investigated if measurements of skin impedance can determine levels of sedation induced by midazolam. Twenty-seven patients scheduled for arthroscopy requiring general anesthesia were served as their own control. These were blinded to the order of injections by telling them that they will be randomly administered a placebo (saline) orsedative agent. A DM 3900 multimeter was used for SI measurements. The degree of sedation was measured using the modified Observer's Assessment of Alertness and Sedation (mOAAS) scale. Resting SI values were noted, and all participants were then administered the placebo followed 5 min later by midazolam 2 mg i.v. Five min after that, patients were administered standard general anesthesia with propofol, oxygen, nitrous oxide 60 %, and isoflurane 1 MAC via a laryngeal mask, and sufentanil 5 - 10 µg. SI significantly increased after administration of midazolam and induction of anesthesia. There were no significant differences between pre-administration (baseline) and placebo and end of surgery and end of anesthesia with closed eyes. There were highly significant differences (p<0.001) between pre-administration vs. midazolam, placebo vs. midazolam, pre-administration vs. induction of anesthesia. We found slight correlation between mOAAS and SI. There were no significant changes between the end of surgery and the end of anesthesia with closed eyes, but SI significantly decreased (p<0.01) after eyes opened.

References

Ledowski T, Pascoe E, Ang B, Schmarbeck T, Clarke M, Fuller C . Monitoring of intra-operative nociception: skin conductance and surgical stress index versus stress hormone plasma levels. Anaesthesia. 2010; 65(10):1001-6. DOI: 10.1111/j.1365-2044.2010.06480.x. View

Ledowski T, Bromilow J, Wu J, Paech M, Storm H, Schug S . The assessment of postoperative pain by monitoring skin conductance: results of a prospective study. Anaesthesia. 2007; 62(10):989-93. DOI: 10.1111/j.1365-2044.2007.05191.x. View

Haberland C, Baker S, Liu H . Bispectral index monitoring of sedation depth in pediatric dental patients. Anesth Prog. 2011; 58(2):66-72. PMC: 3198129. DOI: 10.2344/0003-3006-58.2.66. View

Chernik D, Gillings D, Laine H, Hendler J, Silver J, Davidson A . Validity and reliability of the Observer's Assessment of Alertness/Sedation Scale: study with intravenous midazolam. J Clin Psychopharmacol. 1990; 10(4):244-51. View

Nonaka T, Inamori M, Miyashita T, Inoh Y, Kanoshima K, Higurashi T . Can sedation using a combination of propofol and dexmedetomidine enhance the satisfaction of the endoscopist in endoscopic submucosal dissection?. Endosc Int Open. 2018; 6(1):E3-E10. PMC: 5766333. DOI: 10.1055/s-0043-122228. View

Shetty R, Bellini A, Wijayatilake D, Hamilton M, Jain R, Karanth S . BIS monitoring versus clinical assessment for sedation in mechanically ventilated adults in the intensive care unit and its impact on clinical outcomes and resource utilization. Cochrane Database Syst Rev. 2018; 2:CD011240. PMC: 6353112. DOI: 10.1002/14651858.CD011240.pub2. View

Ueno T, Tremblay J, Kunes J, Zicha J, Dobesova Z, Pausova Z . Gender-specific genetic determinants of blood pressure and organ weight: pharmacogenetic approach. Physiol Res. 2003; 52(6):689-700. View

Bach D . Sympathetic nerve activity can be estimated from skin conductance responses - a comment on Henderson et al. (2012). Neuroimage. 2013; 84:122-3. PMC: 3898862. DOI: 10.1016/j.neuroimage.2013.08.030. View

Kittnar O . Selected sex related differences in pathophysiology of cardiovascular system. Physiol Res. 2019; 69(1):21-31. PMC: 8565954. DOI: 10.33549/physiolres.934068. View

10.

Chapa I, Lange D, Haywood J . Gender differences in sympathetic nervous system regulation. Clin Exp Pharmacol Physiol. 1999; 26(2):122-6. DOI: 10.1046/j.1440-1681.1999.02995.x. View

11.

Winterhalter M, Munte S, Taschenbrecker P, Hecker H, Weilbach C, Osthaus A . Skin impedance correlates to sedation grade, plasma propofol concentrations and bispectral index during a target-controlled infusion of propofol. Eur J Anaesthesiol. 2009; 26(7):589-96. DOI: 10.1097/EJA.0b013e328329b149. View

12.

Winterhalter M, Munte S, Gerhard M, Danzeisen O, Juttner T, Monaca E . Prospective study comparing skin impedance with EEG parameters during the induction of anaesthesia with fentanyl and etomidate. Eur J Med Res. 2010; 15(2):47-53. PMC: 3352044. DOI: 10.1186/2047-783x-15-2-47. View

13.

Valkenburg A, Niehof S, Dijk M, Verhaar E, Tibboel D . Skin conductance peaks could result from changes in vital parameters unrelated to pain. Pediatr Res. 2012; 71(4 Pt 1):375-9. DOI: 10.1038/pr.2011.72. View

14.

Chisholm C, Zurica J, Mironov D, Sciacca R, Ornstein E, Heyer E . Comparison of electrophysiologic monitors with clinical assessment of level of sedation. Mayo Clin Proc. 2006; 81(1):46-52. PMC: 1413967. DOI: 10.4065/81.1.46. View

15.

Czaplik M, Hubner C, Kony M, Kaliciak J, Kezze F, Leonhardt S . Acute pain therapy in postanesthesia care unit directed by skin conductance: a randomized controlled trial. PLoS One. 2012; 7(7):e41758. PMC: 3407175. DOI: 10.1371/journal.pone.0041758. View

16.

Gunther A, Bottai M, Schandl A, Storm H, Rossi P, Sackey P . Palmar skin conductance variability and the relation to stimulation, pain and the motor activity assessment scale in intensive care unit patients. Crit Care. 2013; 17(2):R51. PMC: 3672492. DOI: 10.1186/cc12571. View

17.

Storm H . Changes in skin conductance as a tool to monitor nociceptive stimulation and pain. Curr Opin Anaesthesiol. 2008; 21(6):796-804. DOI: 10.1097/ACO.0b013e3283183fe4. View

18.

Cowen R, Stasiowska M, Laycock H, Bantel C . Assessing pain objectively: the use of physiological markers. Anaesthesia. 2015; 70(7):828-47. DOI: 10.1111/anae.13018. View

19.

Gjerstad A, Storm H, Hagen R, Huiku M, Qvigstad E, Raeder J . Comparison of skin conductance with entropy during intubation, tetanic stimulation and emergence from general anaesthesia. Acta Anaesthesiol Scand. 2007; 51(1):8-15. DOI: 10.1111/j.1399-6576.2006.01189.x. View

20.

Winterhalter M, Schiller J, Munte S, Bund M, Hoy L, Weilbach C . Prospective investigation into the influence of various stressors on skin impedance. J Clin Monit Comput. 2007; 22(1):67-74. DOI: 10.1007/s10877-007-9107-7. View