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Erschienen in: Journal of Clinical Monitoring and Computing 4/2020

20.08.2019 | Original Research

Differentiation of skin incision and laparoscopic trocar insertion via quantifying transient bradycardia measured by electrocardiogram

verfasst von: Cheng-Hsi Chang, Yue-Lin Fang, Yu-Jung Wang, Hau-Tieng Wu, Yu-Ting Lin

Erschienen in: Journal of Clinical Monitoring and Computing | Ausgabe 4/2020

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Abstract

Most surgical procedures involve structures deeper than the skin. However, the difference in surgical noxious stimulation between skin incision and laparoscopic trocar insertion is unknown. By analyzing instantaneous heart rate (IHR) calculated from the electrocardiogram, in particular the transient bradycardia in response to surgical stimuli, this study investigates surgical noxious stimuli arising from skin incision and laparoscopic trocar insertion, and their difference. Thirty-five patients undergoing laparoscopic cholecystectomy were enrolled in this prospective observational study. Sequential surgical steps including umbilical skin incision (11 mm), umbilical trocar insertion (11 mm), xiphoid skin incision (5 mm), xiphoid trocar insertion (5 mm), subcostal skin incision (3 mm), and subcostal trocar insertion (3 mm) were investigated. IHR was derived from electrocardiography and calculated by the modern time-varying power spectrum. Similar to the classical heart rate variability analysis, the time-varying low frequency power (tvLF), time-varying high frequency power (tvHF), and tvLF-to-tvHF ratio (tvLHR) were calculated. Prediction probability (PK) analysis and global pointwise F-test were used to compare the statistical performance between indices and the heart rate readings from the patient monitor. Analysis of IHR showed that surgical stimulus elicits a transient bradycardia, followed by the increase of heart rate. Transient bradycardia is more significant in trocar insertion than skin incision (p < 0.001 for tvHF). The IHR change quantifies differential responses to different surgical intensity. Serial PK analysis demonstrates de-sensitization in skin incision, but not in laparoscopic trocar insertion. Quantitative indices present the transient bradycardia introduced by noxious stimulation. The results indicate different effects between skin incision and trocar insertion.
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Literatur
1.
Zurück zum Zitat Funcke S, Sauerlaender S, Pinnschmidt HO, et al. Validation of innovative techniques for monitoring nociception during general anesthesia: a clinical study using tetanic and intracutaneous electrical stimulation. Anesthesiology. 2017;127:272–83. CrossRef Funcke S, Sauerlaender S, Pinnschmidt HO, et al. Validation of innovative techniques for monitoring nociception during general anesthesia: a clinical study using tetanic and intracutaneous electrical stimulation. Anesthesiology. 2017;127:272–83. CrossRef
2.
Zurück zum Zitat Gruenewald M, Ilies C, Herz J, et al. Influence of nociceptive stimulation on analgesia nociception index (ANI) during propofol-remifentanil anaesthesia. Br J Anaesth. 2013;110:1024–30. CrossRef Gruenewald M, Ilies C, Herz J, et al. Influence of nociceptive stimulation on analgesia nociception index (ANI) during propofol-remifentanil anaesthesia. Br J Anaesth. 2013;110:1024–30. CrossRef
3.
Zurück zum Zitat Huiku M, Uutela K, van Gils M, et al. Assessment of surgical stress during general anaesthesia. Br J Anaesth. 2007;98:447–55. CrossRef Huiku M, Uutela K, van Gils M, et al. Assessment of surgical stress during general anaesthesia. Br J Anaesth. 2007;98:447–55. CrossRef
4.
Zurück zum Zitat Logier R, Jeanne M, Dassonneville A, Delecroix M, Tavernier B. PhysioDoloris: a monitoring device for analgesia/nociception balance evaluation using heart rate variability analysis. Conf Proc IEEE Eng Med Biol Soc. IEEE; 2010; 1194–1197. Logier R, Jeanne M, Dassonneville A, Delecroix M, Tavernier B. PhysioDoloris: a monitoring device for analgesia/nociception balance evaluation using heart rate variability analysis. Conf Proc IEEE Eng Med Biol Soc. IEEE; 2010; 1194–1197.
5.
Zurück zum Zitat Seitsonen ER, Korhonen IK, van Gils MJ, et al. EEG spectral entropy, heart rate, photoplethysmography and motor responses to skin incision during sevoflurane anaesthesia. Acta Anaesthesiol Scand. 2005;49:284–92. CrossRef Seitsonen ER, Korhonen IK, van Gils MJ, et al. EEG spectral entropy, heart rate, photoplethysmography and motor responses to skin incision during sevoflurane anaesthesia. Acta Anaesthesiol Scand. 2005;49:284–92. CrossRef
6.
Zurück zum Zitat Laitio RM, Kaskinoro K, Särkelä MO, et al. Bispectral index, entropy, and quantitative electroencephalogram during single-agent xenon anesthesia. Anesthesiology. 2008;108:63–70. CrossRef Laitio RM, Kaskinoro K, Särkelä MO, et al. Bispectral index, entropy, and quantitative electroencephalogram during single-agent xenon anesthesia. Anesthesiology. 2008;108:63–70. CrossRef
7.
Zurück zum Zitat Ekman A, Brudin L, Sandin R. A comparison of bispectral index and rapidly extracted auditory evoked potentials index responses to noxious stimulation during sevoflurane anesthesia. Anesth Analg. 2004;99:1141–6. CrossRef Ekman A, Brudin L, Sandin R. A comparison of bispectral index and rapidly extracted auditory evoked potentials index responses to noxious stimulation during sevoflurane anesthesia. Anesth Analg. 2004;99:1141–6. CrossRef
8.
Zurück zum Zitat Klockars JG, Hiller A, Münte S, van Gils MJ, Taivainen T. Spectral entropy as a measure of hypnosis and hypnotic drug effect of total intravenous anesthesia in children during slow induction and maintenance. Anesthesiology. 2012;116:340–51. CrossRef Klockars JG, Hiller A, Münte S, van Gils MJ, Taivainen T. Spectral entropy as a measure of hypnosis and hypnotic drug effect of total intravenous anesthesia in children during slow induction and maintenance. Anesthesiology. 2012;116:340–51. CrossRef
9.
Zurück zum Zitat Zbinden AM, Petersen-Felix S, Thomson DA. Anesthetic depth defined using multiple noxious stimuli during isoflurane/oxygen anesthesia. II. Hemodynamic responses. Anesthesiology. 1994;80:261–7. CrossRef Zbinden AM, Petersen-Felix S, Thomson DA. Anesthetic depth defined using multiple noxious stimuli during isoflurane/oxygen anesthesia. II. Hemodynamic responses. Anesthesiology. 1994;80:261–7. CrossRef
10.
Zurück zum Zitat Rantanen M, Yppärilä-Wolters H, van Gils M, et al. Tetanic stimulus of ulnar nerve as a predictor of heart rate response to skin incision in propofol remifentanil anaesthesia. Br J Anaesth. 2007;99:509–13. CrossRef Rantanen M, Yppärilä-Wolters H, van Gils M, et al. Tetanic stimulus of ulnar nerve as a predictor of heart rate response to skin incision in propofol remifentanil anaesthesia. Br J Anaesth. 2007;99:509–13. CrossRef
11.
Zurück zum Zitat Pogatzki-Zahn EM, Wagner C, Meinhardt-Renner A, et al. Coding of incisional pain in the brain: a functional magnetic resonance imaging study in human volunteers. Anesthesiology. 2010;112:406–17. CrossRef Pogatzki-Zahn EM, Wagner C, Meinhardt-Renner A, et al. Coding of incisional pain in the brain: a functional magnetic resonance imaging study in human volunteers. Anesthesiology. 2010;112:406–17. CrossRef
12.
Zurück zum Zitat Feinstein B, Langton JN, Jameson RM, Schiller F. Experiments on pain referred from deep somatic tissues. J Bone Joint Surg Am. 1954;36:981–97. CrossRef Feinstein B, Langton JN, Jameson RM, Schiller F. Experiments on pain referred from deep somatic tissues. J Bone Joint Surg Am. 1954;36:981–97. CrossRef
13.
Zurück zum Zitat Graven-Nielsen T. Fundamentals of muscle pain, referred pain, and deep tissue hyperalgesia. Scand J Rheumatol Suppl. 2006;122:1–43. CrossRef Graven-Nielsen T. Fundamentals of muscle pain, referred pain, and deep tissue hyperalgesia. Scand J Rheumatol Suppl. 2006;122:1–43. CrossRef
14.
Zurück zum Zitat Hall JE. Somatic Sensations: II. Pain, Headache, and Thermal Sensations. In: Hall JE, editor. Guyton and Hall Textbook of Medical Physiology. 13th ed. Philadelphia: Saunders Elsevier; 2015. p. 621–32. Hall JE. Somatic Sensations: II. Pain, Headache, and Thermal Sensations. In: Hall JE, editor. Guyton and Hall Textbook of Medical Physiology. 13th ed. Philadelphia: Saunders Elsevier; 2015. p. 621–32.
15.
Zurück zum Zitat Lin YT, Wu HT. ConceFT for time-varying heart rate variability analysis as a measure of noxious stimulation during general anesthesia. IEEE Trans Biomed Eng. 2017;64:145–54. CrossRef Lin YT, Wu HT. ConceFT for time-varying heart rate variability analysis as a measure of noxious stimulation during general anesthesia. IEEE Trans Biomed Eng. 2017;64:145–54. CrossRef
16.
Zurück zum Zitat Daubechies I, Wang YG, Wu HT. ConceFT: concentration of frequency and time via a multitapered synchrosqueezed transform. Phil Trans A Math Phys Eng Sci. 2016;374:20150193. CrossRef Daubechies I, Wang YG, Wu HT. ConceFT: concentration of frequency and time via a multitapered synchrosqueezed transform. Phil Trans A Math Phys Eng Sci. 2016;374:20150193. CrossRef
17.
Zurück zum Zitat Lin YT, Wu HT, Tsao J, Yien HW, Hseu SS. Time-varying spectral analysis revealing differential effects of sevoflurane anaesthesia: non-rhythmic-to-rhythmic ratio. Acta Anaesthesiol Scand. 2014;58:157–67. CrossRef Lin YT, Wu HT, Tsao J, Yien HW, Hseu SS. Time-varying spectral analysis revealing differential effects of sevoflurane anaesthesia: non-rhythmic-to-rhythmic ratio. Acta Anaesthesiol Scand. 2014;58:157–67. CrossRef
18.
Zurück zum Zitat Lin YT, Flandrin P, Wu HT. When Interpolation-Induced Reflection Artifact Meets Time-Frequency Analysis. IEEE Trans Biomed Eng. 2016;63:2133–41. CrossRef Lin YT, Flandrin P, Wu HT. When Interpolation-Induced Reflection Artifact Meets Time-Frequency Analysis. IEEE Trans Biomed Eng. 2016;63:2133–41. CrossRef
19.
Zurück zum Zitat Task Force of the European Society of Cardiology. Heart rate variability, standards of measurement, physiological interpretation, and clinical use. Circulation. 1996;93:1043–65. CrossRef Task Force of the European Society of Cardiology. Heart rate variability, standards of measurement, physiological interpretation, and clinical use. Circulation. 1996;93:1043–65. CrossRef
20.
Zurück zum Zitat Smith WD, Dutton RC, Smith TN. Measuring the performance of anesthetic depth indicators. Anesthesiology. 1996;84:38–51. CrossRef Smith WD, Dutton RC, Smith TN. Measuring the performance of anesthetic depth indicators. Anesthesiology. 1996;84:38–51. CrossRef
21.
Zurück zum Zitat Zhang JT, Liang X. One-way ANOVA for functional data via globalizing the pointwise F-test. Scand J Stat. 2014;41:51–71. CrossRef Zhang JT, Liang X. One-way ANOVA for functional data via globalizing the pointwise F-test. Scand J Stat. 2014;41:51–71. CrossRef
22.
Zurück zum Zitat Brignole M, Menozzi C, Bottoni N, et al. Mechanisms of syncope caused by transient bradycardia and the diagnostic value of electrophysiolopic testing and cardiovascular reflexivity maneuvers. Am J Cardiol. 1995;76:273–8. CrossRef Brignole M, Menozzi C, Bottoni N, et al. Mechanisms of syncope caused by transient bradycardia and the diagnostic value of electrophysiolopic testing and cardiovascular reflexivity maneuvers. Am J Cardiol. 1995;76:273–8. CrossRef
23.
Zurück zum Zitat Porges SW. The polyvagal perspective. Biol Psychol. 2007;74:116–43. CrossRef Porges SW. The polyvagal perspective. Biol Psychol. 2007;74:116–43. CrossRef
24.
Zurück zum Zitat Kosaka M, Asamura SI, Kamiishi H. Oculocardiac reflex induced by zygomatic fracture; a case report. J Craniomaxillofac Surg. 2000;28:106–9. CrossRef Kosaka M, Asamura SI, Kamiishi H. Oculocardiac reflex induced by zygomatic fracture; a case report. J Craniomaxillofac Surg. 2000;28:106–9. CrossRef
25.
Zurück zum Zitat Hahnenkamp K, Hönemann CW, Fischer LG, Durieux ME, Muehlendyck H, Braun U. Effect of different anaesthetic regimes on the oculocardiac reflex during paediatric strabismus surgery. Paediatr Anaesth. 2000;10:601–8. CrossRef Hahnenkamp K, Hönemann CW, Fischer LG, Durieux ME, Muehlendyck H, Braun U. Effect of different anaesthetic regimes on the oculocardiac reflex during paediatric strabismus surgery. Paediatr Anaesth. 2000;10:601–8. CrossRef
26.
Zurück zum Zitat Brantley JC 3rd, Riley PM. Cardiovascular collapse during laparoscopy: a report of two cases. Am J Obstet Gynecol. 1988;159:735–7. CrossRef Brantley JC 3rd, Riley PM. Cardiovascular collapse during laparoscopy: a report of two cases. Am J Obstet Gynecol. 1988;159:735–7. CrossRef
27.
Zurück zum Zitat Boscan P, Paton JF. Role of the solitary tract nucleus in mediating nociceptive evoked cardiorespiratory responses. Auton Neurosci. 2001;86:170–82. CrossRef Boscan P, Paton JF. Role of the solitary tract nucleus in mediating nociceptive evoked cardiorespiratory responses. Auton Neurosci. 2001;86:170–82. CrossRef
28.
Zurück zum Zitat Paton JF, Nalivaiko E, Boscan P, Pickering AE. Reflexly evoked coactivation of cardiac vagal and sympathetic motor outflows: observations and functional implications. Clin Exp Pharmacol Physiol. 2006;33:1245–50. CrossRef Paton JF, Nalivaiko E, Boscan P, Pickering AE. Reflexly evoked coactivation of cardiac vagal and sympathetic motor outflows: observations and functional implications. Clin Exp Pharmacol Physiol. 2006;33:1245–50. CrossRef
29.
Zurück zum Zitat American National Standard: Requirement. In: American National Standard. Cardiac monitors, heart rate meters, and alarms, ANSI/AAMI EC13:2002/(R)2007, 2007; 7–13. American National Standard: Requirement. In: American National Standard. Cardiac monitors, heart rate meters, and alarms, ANSI/AAMI EC13:2002/(R)2007, 2007; 7–13.
30.
Zurück zum Zitat Keay KA, Clement CI, Owler B, Depaulis A, Bandler R. Convergence of deep somatic and visceral nociceptive information onto a discrete ventrolateral midbrain periaqueductal gray region. Neuroscience. 1994;61:727–32. CrossRef Keay KA, Clement CI, Owler B, Depaulis A, Bandler R. Convergence of deep somatic and visceral nociceptive information onto a discrete ventrolateral midbrain periaqueductal gray region. Neuroscience. 1994;61:727–32. CrossRef
31.
Zurück zum Zitat Keay KA, Crowfoot LJ, Floyd NS, Henderson LA, Christie MJ, Bandler R. Cardiovascular effects of microinjections of opioid agonists into the depressor region of the ventrolateral periaqueductal gray region. Brain Res. 1997;762:61–71. CrossRef Keay KA, Crowfoot LJ, Floyd NS, Henderson LA, Christie MJ, Bandler R. Cardiovascular effects of microinjections of opioid agonists into the depressor region of the ventrolateral periaqueductal gray region. Brain Res. 1997;762:61–71. CrossRef
32.
Zurück zum Zitat Behbehani MM. Functional characteristics of the midbrain periaqueductal gray. Prog Neurobiol. 1995;46:575–605. CrossRef Behbehani MM. Functional characteristics of the midbrain periaqueductal gray. Prog Neurobiol. 1995;46:575–605. CrossRef
33.
Zurück zum Zitat Morgan MM, Whitney PK, Gold MS. Immobility and flight associated with antinociception produced by activation of the ventral and lateral/dorsal regions of the rat periaqueductal gray. Brain Res. 1998;804:159–66. CrossRef Morgan MM, Whitney PK, Gold MS. Immobility and flight associated with antinociception produced by activation of the ventral and lateral/dorsal regions of the rat periaqueductal gray. Brain Res. 1998;804:159–66. CrossRef
34.
Zurück zum Zitat Henderson LA, Keay KA, Bandler R. The ventrolateral periaqueductal gray projects to caudal brainstem depressor regions: a functional-anatomical and physiological study. Neuroscience. 1998;82:201–21. CrossRef Henderson LA, Keay KA, Bandler R. The ventrolateral periaqueductal gray projects to caudal brainstem depressor regions: a functional-anatomical and physiological study. Neuroscience. 1998;82:201–21. CrossRef
35.
Zurück zum Zitat Strigo IA, Duncan GH, Boivin M, Bushnell MC. Differentiation of visceral and cutaneous pain in the human brain. J Neurophysiol. 2003;89:3294–303. CrossRef Strigo IA, Duncan GH, Boivin M, Bushnell MC. Differentiation of visceral and cutaneous pain in the human brain. J Neurophysiol. 2003;89:3294–303. CrossRef
36.
Zurück zum Zitat Green AL, Paterson DJ. Identification of neurocircuitry controlling cardiovascular function in humans using functional neurosurgery: implications for exercise control. Exp Physiol. 2008;93:1022–8. CrossRef Green AL, Paterson DJ. Identification of neurocircuitry controlling cardiovascular function in humans using functional neurosurgery: implications for exercise control. Exp Physiol. 2008;93:1022–8. CrossRef
Metadaten
Titel
Differentiation of skin incision and laparoscopic trocar insertion via quantifying transient bradycardia measured by electrocardiogram
verfasst von
Cheng-Hsi Chang
Yue-Lin Fang
Yu-Jung Wang
Hau-Tieng Wu
Yu-Ting Lin
Publikationsdatum
20.08.2019
Verlag
Springer Netherlands
Erschienen in
Journal of Clinical Monitoring and Computing / Ausgabe 4/2020
Print ISSN: 1387-1307
Elektronische ISSN: 1573-2614
DOI
https://doi.org/10.1007/s10877-019-00378-w

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