[Turk J Anaesthesiol Reanim]
Turk J Anaesthesiol Reanim. Baskıdaki Makaleler: TARD-56688

Area under the curve of the finger photoplethysmography as the evaluation measure for sympathetic activity during lumbar epidural anaesthesia

Slobodan Mihaljevic1, Milenko Bevanda2, Kresimir Reiner1, Krunoslav Sporcic3, Ljiljana Mihaljevic1, Marko Cacic4
1Department for Anaesthesiology and Intensive Care Medicine, Clinic for Obstetrics and Gynecology, Clinical Hospital Center Zagreb, Zagreb, Croatia
2Department for Internal Medicine, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
3Department for Anaesthesiology, Reanimation and Intensive Care Medicine, General Hospital Vinkovci, Vinkovci, Croatia
4St. Antonius Krankenhaus Kleve, Kleve, Germany

Objective: Detecting the changes of the finger photoplethysmography after administration of epidural anesthesia is a surrogate method for evaluation of autonomic nervous system activity.
Methods: We included total of 46 patients scheduled for elective surgical procedure under lumbar epidural anesthesia. Biopac SS4LA Pulse Plethysmograph Transducer was used for photoplethysmography recording and the photoplethysmographic device was placed on the first finger of the right leg. First standard lead of the electrocardiogram was measured simultaneously with the finger photoplethysmography. First measurement was done before administration of epidural anesthesia and second measurement was done 25 minutes after administration of epidural anesthesia.
Results: Area under the curve of the finger photoplethysmography was statistically significantly increased 25 minutes after administration of epidural anesthesia compared with the first measurement (p=0.0001). The amplitude of the finger photoplethysmography, as well as the pulse transit time were also statistically significantly increased after administration of epidural anesthesia.
Conclusion: Area under the curve reflects changes in sympathetic activity after epidural anaesthesia below the level of the block. It can be used for detection of the degree of the sympathetic block and respecetively for the succes of the epidural block. Future is also seen in the detection of the sympathetic block cessation, as an indicator for the discharge from the awakening room and the beginning of the patient verticalisation.

Keywords: finger photoplethysmography, epidural anesthesia, area under the curve, sympathetic blockade

Sorumlu Yazar: Kresimir Reiner, Croatia

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