SPI To Monitor The Accuracy Of Intraoperative Noxious Stimulation In Elderly Patients

Objective:To observe the specificity,sensitivity and trend of SPI and hemodynamic parameters in response to noxious stimulation in elderly patients undergoing general anesthesia,and to further evaluate the value of SPI in pain monitoring in elderly patients undergoing laparoscopic surgery.Methods:Thirty-five patients underwent elective gynecological laparoscopic surgery,ASA grade I to II,NYHA grade I to II,age 65 to 80years,and BMI 18 to 30 kg/m2.All operations were performed by the same group of surgeons.After the patient entered the room,he was placed supine,warm blanket insulation,open upper extremity venous access,infusion of hydroxyethyl starch 4ml/kg,oxygen and connected to GE B650 monitor,routine monitoring of non-invasive arterial pressure?NIBP?,electrocardio-gram?ECG,and blood?Oxygen saturation?SP02?,end-tidal carbon dioxide?PetCO₂?,bispectral index?BIS?and SPI?GE,Finland?and body temperature monitoring.SPI and monitoring oxygen saturation share a finger sleeve,clamped on the index finger The local anesthesia was placed in the right radial artery and the invasive arterial blood pressure?ABP?and pulse pressure variability?PPV?were monitored.The degree of neuromuscular block was monitored by TOF muscle relaxation monitor.Intravenous midazolam 0.03Mg/kg,sufentanil 0.3?g/kg,etomidate 0.3mg/kg,when the patient's consciousness disappears?eyelash reflex disappears,no response to the instruction,BIS is less than 60?,intravenous cis-atracurium 0.2mg/kg,induction of anesthesia.Mechanical ventilation after tracheal intubation,setting tidal volume 6⁸ml/kg,respiratory rate 12¹4 times/min,maintaining P_ETCO₂ at 35⁴5mmHg.Inhaled sevoflurane,target-controlled infusion Remifentanil maintains anesthesia.Inhaled 1.5%to 3%of sevoflurane to maintain a BIS value of 45 Between⁶0.Target-controlled infusion of remifentanil,maintain the effector chamber target concentration of 2ng/ml⁶ng/ml.Add cis atracurium 0.05mg/kg according to the situation,maintain T4/T1 is 0.Record separately Noxious stimulation,ie MAP,HR,BIS within2 min after intubation,after intubation,before incision,after incision,before pneumoperitoneum,after pneumoperitoneum,before the strongest stimulation point,and after the strongest stimulation point Value and SPI were recorded every 30s.The difference between the maximum value of MAP,HR,SPI and the baseline value within 1 min and 2 min after MAP,HR,SPI and noxious stimulation at each time point before the noxious stimulation,?MAP,?HR,?SPI.MAP,HR,SPI and SPI,HR,SPI were used to determine the nociceptive stimuli after MAP,HR,SPI and noxious stimulation at the time of 120s,90s,60s and 30s.Receiver operating characteristic curve?ROC?,and calculate the area under the curve?AUC?,determine its threshold,sensitivity,specificity and Yoden index 15.MAP,HR,SPI and baseline values before the noxious stimulation Difference between the maximum value of MAP,HR,SPI and the difference between the baseline value and the baseline value within 1 min and2 min after the difference and noxious stimulation?MAP?HR,?SPI,plot?SPI,?MAP,?HR to determine the ROC curve of noxious stimulation,and calculate AUC,determine its threshold,sensitivity,specificity and Yoden index.P<0.05 is statistically significant.Result:The response of the maximum value within 2 min of each parameter to the skin stimuli was AU.The AUC of the SPI was 0.907,the AUC of the MAP was 0.759,and the AUC of the HR was 0.631.The difference between the maximum value of each parameter within 2 min and the noxious stimulus.The response of the delta value to the cleavage stimulation,the AUC of?SPI was 0.977,the AUC of?MAP was 0.841,and the AUC of?HR was 0.861.Conclusion:1.In the elderly patients with general anesthesia laparoscopic surgery,SPI can effectively detect noxious stimulation,and is superior to HR and MAP.2.The difference between SPI before and after noxious stimulation,ie?SPI,is better than SPI in detecting noxious stimulation.