Original Article

Changes in the photoplethysmogram with tracheal intubation and remifentanil concentration

  1. X. Wang1,7,
  2. X. Chen5,
  3. S. Ye2,
  4. Y. Feng6,
  5. C. Huang1,
  6. L. Hou3,
  7. J. Liu3,
  8. H. Chen4

Article first published online: 28 SEP 2012

DOI: 10.1111/anae.12001

Issue

Anaesthesia

Anaesthesia

Volume 67, Issue 12, pages 1332–1336, December 2012

Additional Information

How to Cite

Wang, X., Chen, X., Ye, S., Feng, Y., Huang, C., Hou, L., Liu, J. and Chen, H. (2012), Changes in the photoplethysmogram with tracheal intubation and remifentanil concentration. Anaesthesia, 67: 1332–1336. doi: 10.1111/anae.12001

Author Information

  1. 1

     PhD Student,

  2. 2

     Associate Professor,

  3. 3

     Masters Student,

  4. 4

     Professor, The Key Laboratory of Biomedical Engineering of Ministry of Education, College of Biomedical Engineering and Instrument Science, Zhejiang University, Zhejiang, China

  5. 5

     Chief Anaesthetist, Professor and Director,

  6. 6

     Attending Anaesthetist, Department of Anaesthesia, Women's Hospital, School of Medicine, Zhejiang University, Zhejiang, China

  7. 7

     Lecturer, Shanghai Medical Instrumentation College, University of Shanghai for Science & Technology, Shanghai, China

* Correspondence to: H. Chen Email: ch-sun@263.net

  1. You can respond to this article at http://www.anaesthesiacorrespondence.com

Publication History

  1. Issue published online: 7 NOV 2012
  2. Article first published online: 28 SEP 2012
  3. Accepted: 19 August 2012

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Summary

Autonomic sympathetic activation, for instance following noxious stimuli, decreases the size and flattens the shape of the photoplethysmographic peripheral pulse waveform. We report a simple measure of the waveform shape, the ratio of mean-to-peak wave amplitude, for measuring nociception level during general anaesthesia. Fifty participants, anaesthetised with propofol and remifentanil, were randomly allocated to one of three different remifentanil effect-site concentrations (1, 3 and 5 ng.ml−1). Tracheal intubation increased the mean (SD) plethysmographic ratio from 0.38 (0.06) to 0.48 (0.04), p = 2.6 × 10−16. The mean (SD) ratios following intubation at remifentanil effect-site concentrations of 1 ng.ml−1, 3 ng.ml−1 and 5 ng.ml−1, were 0.49 (0.03), 0.48 (0.03) and 0.45 (0.04), respectively. Remifentanil therefore suppressed changes in the mean-to-peak ratio caused by tracheal intubation (p = 0.006). The ratio of the mean-to-peak plethysmographic amplitude may represent a simple measure of the balance of autonomic sympathetic and parasympathetic activity under general anaesthesia, and its performance following intubation was significantly different from peak amplitude (p = 0.046).

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