The Effect of Prone Positioning on Surgical Pleth Index in Patients Undergoing Spine Surgery Under General Anesthesia - A Prospective Observational Study

Overview

Journal J Anaesthesiol Clin Pharmacol

Specialty Anesthesiology

Date 2023 Feb 13

PMID 36778835

Authors

Smita Musti

Dhritiman Chakrabarti

Sonia Bansal

Affiliations

Soon will be listed here.

Abstract

Background And Aims: Surgical Pleth Index (SPI) provides an objective assessment of nociception - anti-nociception balance but is influenced by multiple confounders. The effect of change of position on SPI, has not been studied extensively. The aim of the study was to observe the effect of prone positioning on SPI and its correlation with hemodynamic variables, in patients undergoing lumbar and thoracic spine surgery.

Material And Methods: This prospective observational pilot study included 14 patients. In addition to hemodynamic monitoring, SPI, entropy and pulse pressure variability (PPV) were monitored. Propofol and Fentanyl infusions were used for maintenance of anesthesia. The patients were made prone on bolsters and all the variables were recorded every 5 minutes in supine position and after making prone for 20 minutes, before and after incision, muscle splitting and laminectomy.

Results: Comparing the last value of the variables in the supine position with those immediately after making prone, SPI increased by 16.36 units ( = 0.003), followed by gradual reduction over the next 20 minutes. Mean arterial pressure and heart rate increased transiently (value = 0.028 and 0.025, respectively) without any significant change in PPV. Surgical incision also led to a significant increase in SPI.

Conclusion: Prone positioning leads to significant increase in SPI, probably due to increased sympathetic tone.

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References

Bonhomme V, Uutela K, Hans G, Maquoi I, Born J, Brichant J . Comparison of the surgical Pleth Index™ with haemodynamic variables to assess nociception-anti-nociception balance during general anaesthesia. Br J Anaesth. 2010; 106(1):101-11. DOI: 10.1093/bja/aeq291. View

Sudheer P, Logan S, Ateleanu B, Hall J . Haemodynamic effects of the prone position: a comparison of propofol total intravenous and inhalation anaesthesia. Anaesthesia. 2006; 61(2):138-41. DOI: 10.1111/j.1365-2044.2005.04464.x. View

Pump B, Talleruphuus U, Christensen N, Warberg J, Norsk P . Effects of supine, prone, and lateral positions on cardiovascular and renal variables in humans. Am J Physiol Regul Integr Comp Physiol. 2002; 283(1):R174-80. DOI: 10.1152/ajpregu.00619.2001. View

Wadsworth R, Anderton J, Vohra A . The effect of four different surgical prone positions on cardiovascular parameters in healthy volunteers. Anaesthesia. 1996; 51(9):819-22. DOI: 10.1111/j.1365-2044.1996.tb12608.x. View

Wennervirta J, Hynynen M, Koivusalo A, Uutela K, Huiku M, Vakkuri A . Surgical stress index as a measure of nociception/antinociception balance during general anesthesia. Acta Anaesthesiol Scand. 2008; 52(8):1038-45. DOI: 10.1111/j.1399-6576.2008.01687.x. View

Struys M, Vanpeteghem C, Huiku M, Uutela K, Blyaert N, Mortier E . Changes in a surgical stress index in response to standardized pain stimuli during propofol-remifentanil infusion. Br J Anaesth. 2007; 99(3):359-67. DOI: 10.1093/bja/aem173. View

Gruenewald M, Meybohm P, Ilies C, Hocker J, Hanss R, Scholz J . Influence of different remifentanil concentrations on the performance of the surgical stress index to detect a standardized painful stimulus during sevoflurane anaesthesia. Br J Anaesth. 2009; 103(4):586-93. DOI: 10.1093/bja/aep206. View

Wang M, Wang X, Bao R, Zhu W, Bian J, Deng X . Predictive value of the surgical pleth index for the hemodynamic responses to trachea intubation and skin incision. J Clin Monit Comput. 2019; 34(6):1303-1309. DOI: 10.1007/s10877-019-00425-6. View

Ilies C, Ludwigs J, Gruenewald M, Thee C, Hanf J, Hanss R . The effect of posture and anaesthetic technique on the surgical pleth index. Anaesthesia. 2012; 67(5):508-513. DOI: 10.1111/j.1365-2044.2011.07051.x. View

10.

Hans P, Verscheure S, Uutela K, Hans G, Bonhomme V . Effect of a fluid challenge on the Surgical Pleth Index during stable propofol-remifentanil anaesthesia. Acta Anaesthesiol Scand. 2012; 56(6):787-96. DOI: 10.1111/j.1399-6576.2011.02639.x. View

11.

Ahonen J, Jokela R, Uutela K, Huiku M . Surgical stress index reflects surgical stress in gynaecological laparoscopic day-case surgery. Br J Anaesth. 2007; 98(4):456-61. DOI: 10.1093/bja/aem035. View

12.

Huiku M, Uutela K, Van Gils M, Korhonen I, Kymalainen M, Merilainen P . Assessment of surgical stress during general anaesthesia. Br J Anaesth. 2007; 98(4):447-55. DOI: 10.1093/bja/aem004. View

13.

Yokoyama M, Ueda W, Hirakawa M, Yamamoto H . Hemodynamic effect of the prone position during anesthesia. Acta Anaesthesiol Scand. 1991; 35(8):741-4. DOI: 10.1111/j.1399-6576.1991.tb03382.x. View