Journal Article

Effect of surgical pleth index-guided remifentanil administration on perioperative outcomes in elderly patients: a prospective randomized controlled trial

Oh, Seok Kyeong, Lim, Byung Gun, Lee, Do Yeop, Lee, Jae Hak, Won, Young Ju, Kim, Young Sung

2023

Overview

Background During general anesthesia, the surgical pleth index (SPI) monitors nociception. The evidence of SPI in the elderly remains scarce. We aimed to investigate whether there is a difference in perioperative outcomes following intraoperative opioid administration according to the surgical pleth index (SPI) value versus hemodynamic parameters (heart rate or blood pressure) in elderly patients. Methods Patients aged 65–90 years who underwent laparoscopic colorectal cancer surgery under sevoflurane/remifentanil anesthesia were randomized to receive remifentanil guided by SPI (SPI group) or conventional clinical judgment based on hemodynamic parameters (conventional group). The primary endpoint was intraoperative remifentanil consumption. Secondary endpoints were intraoperative hemodynamic instability, pain score, fentanyl consumption and delirium in the post-anesthesia care unit (PACU), and perioperative changes in interleukin-6 and natural killer (NK) cell activity. Results Seventy-five patients (38, SPI; 37, conventional) were included in the study. The SPI group consumed significantly more remifentanil intraoperatively than the conventional group (mean ± SD, 0.13 ± 0.05 vs. 0.06 ± 0.04 μg/kg/min, P  < 0.001). Intraoperative hypertension and tachycardia were more common in the conventional group than in the SPI group. Pain score in the PACU ( P  = 0.013) and the incidence of delirium in the PACU were significantly lower in the SPI group than the conventional group (5.2% vs. 24.3%, P  = 0.02). There was no significant difference in NK cell activity and interleukin-6 level. Conclusions In the elderly patients, SPI-guided analgesia provided appropriate analgesia with sufficient intraoperative remifentanil consumption, lower incidence of hypertension/ tachycardia events, and a lower incidence of delirium in the PACU than the conventional analgesia. However, SPI-guided analgesia may not prevent perioperative immune system deterioration. Trial registration The randomized controlled trial was retrospectively registered in the UMIN Clinical Trials Registry (trial number: UMIN000048351; date of registration: 12/07/2022).

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Aged / Aged patients / Aged, 80 and over / Analgesia / Analgesics, Opioid / Anesthesia / Anesthesia, General / Anesthesiology / Blood pressure / Cancer surgery / Cardiac arrhythmia / Clinical trials / Colorectal cancer / Colorectal surgery / Critical Care Medicine / Delirium / Delirium - drug therapy / Emergency Medicine / Fentanyl / General anesthesia / Heart beat / Heart rate / Hemodynamics / Hospitals / Humans / Hypertension / Hypertension - drug therapy / Hypotension / Immune system / Intensive / Interleukin 6 / Interleukins / Internal Medicine / Killer cells / Laparoscopy / Medicine / Medicine & Public Health / Narcotics / Natural killer cells / NK cell activity / Nociception / Opioid analgesics / Pain - drug therapy / Pain perception / Pain, Postoperative - drug therapy / Patient outcomes / Patients / Prospective Studies / Pulse oximetry / Remifentanil / Remifentanil - therapeutic use / Sevoflurane / Surgical outcomes / Surgical pleth index / Tachycardia