Prediction of Hemodynamic Reactivity by Electroencephalographically Derived Pain Threshold Index in Children Undergoing General Anesthesia: A Prospective Observational Study
Received 19 September 2019
Accepted for publication 15 November 2019
Published 3 December 2019 Volume 2019:12 Pages 3245—3255
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Melinda Thomas
Peer reviewer comments 3
Editor who approved publication: Dr Michael E Schatman
Lei Wu,1,* Siyuan Wang,2,* Yanting Wang,1 Kan Zhang,1 Jie Bai,1 Jijian Zheng1,3
1Department of Anesthesiology, Shanghai Children’s Medical Center Affiliated to School of Medicine, Shanghai Jiao Tong University, Pudong, Shanghai, People’s Republic of China; 2Department of Anesthesiology, 3201 Hospital, Hanzhong City, Shaanxi, People’s Republic of China; 3Pediatric Clinical Pharmacology Laboratory, Shanghai Children’s Medical Center Affiliated to School of Medicine, Shanghai Jiao Tong University, Pudong, Shanghai, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Jijian Zheng
Department of Anesthesiology, Shanghai Children’s Medical Center Affiliated to School of Medicine, Shanghai Jiao Tong University, 1678 Dongfang Road, Pudong, Shanghai 200127, People’s Republic of China
Tel +86 21 38626161
Fax +86 21 58393915
Purpose: The pain threshold index (PTI) is a novel measure of nociception based on integrated electroencephalogram parameters during general anesthesia. The wavelet index (WLI) reflects the depth of sedation. This study aims to evaluate the ability of the PTI and WLI to predict hemodynamic reactivity after tracheal intubation and skin incision in pediatric patients.
Patients and methods: Pediatric patients (n=134) undergoing elective general surgery or urinary surgery were analyzed. Measurements at predefined time-points during tracheal intubation and skin incision included the PTI, WLI, heart rate (HR), and mean blood pressure (MBP). Receiver-operating characteristic (ROC) curves were computed to evaluate the predictive performance of the PTI and WLI in measuring hemodynamic reactivity (an increase of more than 20% in either MBP or HR) during general anesthesia.
Results: Of the 134 patients evaluated, positive reactivity of HR and MBP was observed in 95 (70.9%) and 61 (45.5%) patients induced by intubation, respectively, and 19 (14.2%) and 24 (17.9%) patients induced by skin incision, respectively. Using either HR or MBP reactivity induced by intubation as a dichotomous variable, the areas under the curves (AUCs) [95% CI] of PTI and WLI were 0.81[0.73–0.87] and 0.58[0.49–0.67] with the best cutoff values of 62 and 49. The AUCs [95% CI] of PTI and WLI were 0.82[0.75–0.88] and 0.61[0.52–0.69] after skin incision. The best cutoff values of PTI and WLI were 60 and 46, respectively.
Conclusion: The PTI can predict hemodynamic reactivity with the best cutoff values of 62 and 60 after tracheal intubation and skin incision in pediatric patients during general anesthesia. The WLI failed in predicting hemodynamic changes.
Keywords: pain threshold index, wavelet index, hemodynamic reactivity, pediatric patients
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