Abstract
Automated assessment of circulatory response to surgical stimuli is unsolved. Would detection of cardiac baroreflex inhibition assess adequacy of intra-operative anti-nociception upon incision, as performed on-line on a beat-by-beat basis by a cardiovascular index, CARDEAN™? 18 ASA I-II patients undergoing spinal disc repair were studied, in a prospective randomized single-blinded trial (observational study). During infusion of propofol to maintain bispectral index between 40 and 60, patients were allocated to receive an effect site target-controlled infusion of remifentanil at Ce = 2 or 4 ng ml−1. Upon incision and during surgery, circulatory response was assessed using beat-by-beat measurements of minor hypertension and tachycardia to give a cardiovascular index, CARDEAN, scaled between 0 and 100. Upon skin incision, CARDEAN increased in the remifentanil Ce = 2 ng ml−1 group (n = 7, P < 0.05), while it did not increase in the remifentanil Ce = 4 ng ml−1 group (n = 7, P = 0.18). During surgery, retrospectively, CARDEAN > 60 was associated with tachycardia and hypertension (P k = 0.81 ± 0.10). Changes in CARDEAN appeared linked to adequacy of anti-nociception.
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Acknowledgments
M. Rabilloud, MD, PhD, Associate Professor, Laboratoire de Biostatistiques, Hospices Civils de Lyon, supervised the data analysis. Presented at the ASA meeting, San Diego, CA, and SFAR meeting, Paris, France, fall 2010. PHRC 2005 (CHU Michallon, Grenoble, France) to JFP, OSEO-ANVAR [A05-10-022V] and Fonds d’Innovation du Département du Rhône-Fondation Scientifique de Lyon et Sud Est to AC, Block grants (2006-10) to CNRS 5123 from CNRS-University of Lyon.
Conflict of interest
AC and LQ are shareholders in Alpha-2 Ltd and hold patent of CARDEAN™. AC is a paid consultant of Alpha-2 Ltd. The other investigators report no conflict of interest.
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Rossi, M., Cividjian, A., Fevre, M.C. et al. A beat-by-beat, on-line, cardiovascular index, CARDEAN, to assess circulatory responses to surgery: a randomized clinical trial during spine surgery. J Clin Monit Comput 26, 441–449 (2012). https://doi.org/10.1007/s10877-012-9372-y
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DOI: https://doi.org/10.1007/s10877-012-9372-y