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Noninvasive continuous detection of arterial hypotension during induction of anaesthesia using a photoplethysmographic signal: proof of concept
- Source :
- British Journal of Anaesthesia, British Journal of Anaesthesia, Oxford University Press (OUP), 2019, 122, pp.605-612. ⟨10.1016/j.bja.2019.01.037⟩, British Journal of Anaesthesia, 2019, 122, pp.605-612. ⟨10.1016/j.bja.2019.01.037⟩
- Publication Year :
- 2019
- Publisher :
- HAL CCSD, 2019.
-
Abstract
- Background During general anaesthesia, intraoperative hypotension (IOH), defined as a mean arterial pressure (MAP) reduction of > 20%, is frequent and may lead to complications. Pulse oximetry is mandatory in the operating room, making the photoplethysmographic signal and parameters, such as relative dicrotic notch height (Dicpleth) or perfusion index (PI), readily available. The purpose of this study was to investigate whether relative variations of Dicpleth and PI could detect IOH during anaesthesia induction, and to follow their variations during vasopressor boluses. Methods MAP, Dicpleth, and PI were monitored at 1-min intervals during target control induction of anaesthesia with propofol and remifentanil in 61 subjects. Vasopressor infusion (norepinephrine or phenylephrine) was performed when hypotension occurred according to the decision of the physician. Results The delta in Dicpleth and PI accurately detected IOH, with areas under the receiver operating characteristic curves (AUC) of 0.86 and 0.83, respectively. The optimal thresholds were –19% (sensitivity 79%; specificity 84%) and 51% (sensitivity 82%; specificity 74%) for ΔDicpleth and ΔPI, respectively. There was no difference between the ROC of ΔDicpleth and ΔPI (P=0.22). Combining both ΔDicpleth and ΔPI further improved the hypotension detection power (AUC=0.91) with a sensitivity and specificity of 84%. MAP variations were correlated with ΔDicpleth and ΔPI during vasopressor infusion (r=0.73 and –0.62, respectively; P Conclusions The relative variation in Dicpleth and PI derived from the photoplethysmographic signal can be used as a non invasive, continuous, and simple tool to detect intraoperative hypotension, and to track the vascular response to vasoconstrictor drugs during induction of general anaesthesia. Clinical trial registration NCT03756935 .
- Subjects :
- Adult
Male
Mean arterial pressure
[SDV]Life Sciences [q-bio]
Remifentanil
Hemodynamics
Blood Pressure
Anesthesia, General
Proof of Concept Study
Sensitivity and Specificity
03 medical and health sciences
0302 clinical medicine
030202 anesthesiology
Photoplethysmogram
Monitoring, Intraoperative
medicine
Humans
Vasoconstrictor Agents
General anaesthesia
Prospective Studies
Intraoperative Complications
Photoplethysmography
Intraoperative Care
medicine.diagnostic_test
Receiver operating characteristic
business.industry
Blood Pressure Determination
Middle Aged
Pulse oximetry
Anesthesiology and Pain Medicine
Anesthesia
Female
Hypotension
business
Propofol
medicine.drug
Subjects
Details
- Language :
- English
- ISSN :
- 00070912 and 14716771
- Database :
- OpenAIRE
- Journal :
- British Journal of Anaesthesia, British Journal of Anaesthesia, Oxford University Press (OUP), 2019, 122, pp.605-612. ⟨10.1016/j.bja.2019.01.037⟩, British Journal of Anaesthesia, 2019, 122, pp.605-612. ⟨10.1016/j.bja.2019.01.037⟩
- Accession number :
- edsair.doi.dedup.....4770bdabdc462cdd6da59248115941a5
- Full Text :
- https://doi.org/10.1016/j.bja.2019.01.037⟩