Comparison of surgical stress index (SSI)-guided analgesia and standard clinical practice during routine general anaesthesia : a pilot study
It is well-known that excessive intraoperative stress (nociceptive stimulus) results in various physiological changes, such as immunological, haemodynamic or endocrine ‘stress response’, which thereby may compromise patients’ outcome, influence the length of hospital stay and overall costs of hospital care. To achieve an appropriate balance of nociception – anti-nociception during general anaesthesia is very important and necessary. Achieving an appropriate balance of nociception – anti-nociception during general anaesthesia depends on an indicator which can assess accurately the balance of nociception – anti-nociception to guide analgesic delivery. Surgical stress index (SSI) has been proven to have a better performance in assessing the balance of nociception – anti-nociception during general anaesthesia compared with more traditional variables like blood pressure and heart rate. We designed a prospective, randomized, controlled clinical study, which included two groups – SSI-guided analgesia group and standard analgesia practice group, to investigate the effect of SSI-guided analgesia on recovery time, anaesthetics consumption, incidence of unwanted events during general anaesthesia with propofol and remifentanil during a constant hypnotic level. The results demonstrated that SSI-guided analgesia resulted in a significant reduction of remifentail consumption, less incidence of unwanted events (hypertension, hypotension, tachycardia and movement) and in a similar recovery time during general anaesthesia when compared with the standard analgesia practice protocol. Our study also further proved that SSI has a better performance in detecting the balance of nociception – anti-nociception than state entropy (SE), response entropy (RE), difference between response entropy and state entropy (RE-SE), blood pressure and heart rate during general anaesthesia. However, the ‘ideal’ range of SSI for guiding analgesia needs to be further investigated.
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