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25 March 2014 : Original article  

To clarify features of photoplethysmography in monitoring balanced anesthesia, compared with Cerebral State Index

Lieliang ZhangABCDEF, Lei XuAB, Juan ZhuBC, Yujie GaoC, Zhonghua LuoC, Hongyu WangD, Zhongliang ZhuE, Yi YuE, Hongwei ShiF, Hongguang BaoF

DOI: 10.12659/MSM.889924

Med Sci Monit 2014; 20:481-486


BACKGROUND: Although photoplethysmography and cerebral state index (CSI) have been used as indices in monitoring vital signs perioperatively, there are only a few reports comparing the performance of photoplethysmography with CSI in monitoring anaesthesia depth. The aim of the present study was to clarify features of photoplethysmography in monitoring balanced general anesthesia compared with CSI.

MATERIAL AND METHODS: Forty-five patients undergoing elective operation under general anaesthesia were enrolled in this study. Anaesthesia was induced with target-controlled infusion propofol. The photoplethysmogram, CSI, Modified Observer’s Assessment of Alertness/Sedation Scale (MOAAS), and mean arterial pressure (MAP) were continuously monitored and recorded. Finger photoplethysmogram amplitude (PPGA) and pulse beat interval (PBI) were calculated off-line.

RESULTS: For the period of time from pre-induction to pre-intubation, the coefficient of correlation between MOAAS and CSI was higher than those between MOAAS and PPGA, PBI, and MAP. CSI showed higher prediction probabilities (Pk) to differentiate the levels of MOAAS than did PPGA, PBI, and MAP. PPGA, PBI, and MAP values showed significant differences between before and after intubation, as well as pre- and post-incision (P<0.05), but no significant changes in cerebral state index (P>0.05).

CONCLUSIONS: The present study shows that photoplethysmography-derived parameters appear to be more suitable in monitoring the nociceptive component of balanced general anesthesia, while CSI performs well in detecting the sedation or hypnotic component of balanced general anesthesia.

Keywords: Arterial Pressure - physiology, Balanced Anesthesia - methods, Consciousness Monitors, Intubation, Monitoring, Physiologic - methods, Photoplethysmography, Pulse, young adult

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750