Prediction of the haemodynamic response to tracheal intubation: comparison of laser-Doppler skin vasomotor reflex and pulse wave reflex

2.50
Hdl Handle:
http://hdl.handle.net/2336/31294
Title:
Prediction of the haemodynamic response to tracheal intubation: comparison of laser-Doppler skin vasomotor reflex and pulse wave reflex
Authors:
Luginbühl, M; Reichlin, F; Sigurdsson, G H; Zbinden, A M; Petersen-Felix, S
Citation:
Br J Anaesth. 2002, 89(3):389-97
Issue Date:
1-Sep-2002
Abstract:
BACKGROUND: The laser-Doppler skin vasomotor reflex (SVmR) caused by tetanic stimulation of the ulnar nerve may be a test that can predict the haemodynamic response to tracheal intubation. A decrease in pulse wave amplitude (pulse wave reflex, PWR) may be an alternative index of this response. We compared the abilities of PWR and SVmR to predict the haemodynamic response to tracheal intubation and studied how alfentanil, muscle relaxation, stimulation site and stimulation pattern affected the two reflexes. METHODS: Anaesthesia was induced and maintained with 2% sevoflurane and 50% nitrous oxide in two groups of 10 ASA status 1 patients. Tetanic stimuli were applied to the flexor muscles of the forearm and the ulnar nerve before and after administration of vecuronium. The change in skin blood flow (laser-Doppler) and pulse wave amplitude (pulse oximetry) after a 5 and 10 s stimulation was measured on the opposite hand. If skin blood flow (laser-Doppler) decreased by more than 10%, a computer-controlled infusion of alfentanil was started and the target plasma concentration was increased in steps until this response was suppressed (< 10%). The trachea was intubated and arterial pressure and heart rate responses were recorded. Plasma alfentanil concentration was measured. RESULTS: When PWR and SVmR were suppressed, the haemodynamic response to tracheal intubation was reduced in 100 and 53% of patients respectively. PWR and SVmR responses decreased with increasing plasma alfentanil concentration. The SVmR response to muscle stimulation was reduced by muscle relaxants. The pulse wave response to both muscle and neural stimulation was reduced by relaxants. The responses to 5 and 10 s stimulations were similar. CONCLUSION: An absent SVmR does not predict a blunted arterial pressure or heart rate response to tracheal intubation. The PWR may be a better predictor.
Description:
Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/Open
Additional Links:
http://bja.oxfordjournals.org/cgi/content/abstract/89/3/389

Full metadata record

DC FieldValue Language
dc.contributor.authorLuginbühl, M-
dc.contributor.authorReichlin, F-
dc.contributor.authorSigurdsson, G H-
dc.contributor.authorZbinden, A M-
dc.contributor.authorPetersen-Felix, S-
dc.date.accessioned2008-07-08T13:52:54Z-
dc.date.available2008-07-08T13:52:54Z-
dc.date.issued2002-09-01-
dc.date.submitted2008-07-06-
dc.identifier.citationBr J Anaesth. 2002, 89(3):389-97en
dc.identifier.issn0007-0912-
dc.identifier.pmid12402716-
dc.identifier.doi10.1093/bja/aef196-
dc.identifier.urihttp://hdl.handle.net/2336/31294-
dc.descriptionNeðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/Openen
dc.description.abstractBACKGROUND: The laser-Doppler skin vasomotor reflex (SVmR) caused by tetanic stimulation of the ulnar nerve may be a test that can predict the haemodynamic response to tracheal intubation. A decrease in pulse wave amplitude (pulse wave reflex, PWR) may be an alternative index of this response. We compared the abilities of PWR and SVmR to predict the haemodynamic response to tracheal intubation and studied how alfentanil, muscle relaxation, stimulation site and stimulation pattern affected the two reflexes. METHODS: Anaesthesia was induced and maintained with 2% sevoflurane and 50% nitrous oxide in two groups of 10 ASA status 1 patients. Tetanic stimuli were applied to the flexor muscles of the forearm and the ulnar nerve before and after administration of vecuronium. The change in skin blood flow (laser-Doppler) and pulse wave amplitude (pulse oximetry) after a 5 and 10 s stimulation was measured on the opposite hand. If skin blood flow (laser-Doppler) decreased by more than 10%, a computer-controlled infusion of alfentanil was started and the target plasma concentration was increased in steps until this response was suppressed (< 10%). The trachea was intubated and arterial pressure and heart rate responses were recorded. Plasma alfentanil concentration was measured. RESULTS: When PWR and SVmR were suppressed, the haemodynamic response to tracheal intubation was reduced in 100 and 53% of patients respectively. PWR and SVmR responses decreased with increasing plasma alfentanil concentration. The SVmR response to muscle stimulation was reduced by muscle relaxants. The pulse wave response to both muscle and neural stimulation was reduced by relaxants. The responses to 5 and 10 s stimulations were similar. CONCLUSION: An absent SVmR does not predict a blunted arterial pressure or heart rate response to tracheal intubation. The PWR may be a better predictor.en
dc.language.isoenen
dc.publisherOxford University Pressen
dc.relation.urlhttp://bja.oxfordjournals.org/cgi/content/abstract/89/3/389en
dc.subject.meshAdulten
dc.subject.meshAlfentanilen
dc.subject.meshAnesthetics, Intravenousen
dc.subject.meshBaroreflexen
dc.subject.meshBlood Pressureen
dc.subject.meshFemaleen
dc.subject.meshHeart Rateen
dc.subject.meshHemodynamicsen
dc.subject.meshHumansen
dc.subject.meshIntubation, Intratrachealen
dc.subject.meshLaser-Doppler Flowmetryen
dc.subject.meshMaleen
dc.subject.meshMiddle Ageden
dc.subject.meshMuscle Relaxationen
dc.subject.meshPredictive Value of Testsen
dc.subject.meshPulseen
dc.subject.meshReflexen
dc.titlePrediction of the haemodynamic response to tracheal intubation: comparison of laser-Doppler skin vasomotor reflex and pulse wave reflexen
dc.typeArticleen
dc.contributor.departmentDepartment of Anaesthesiology, University Hospital of Bern, CH-3010 Bern, Switzerland.en
dc.identifier.journalBritish journal of anaesthesiaen

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