Area Under the Curve of Finger Photoplethysmography as an Evaluation Measure for Sympathetic Activity During Lumbar Epidural Anaesthesia [Turk J Anaesthesiol Reanim]
Turk J Anaesthesiol Reanim. 2018; 46(2): 147-150 | DOI: 10.5152/TJAR.2018.56688  

Area Under the Curve of Finger Photoplethysmography as an 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: To detect changes in finger photoplethysmography after administration of epidural anaesthesia as a surrogate method for evaluating autonomic nervous system activity.
Methods: We included a total of 46 patients scheduled for elective surgical procedures under lumbar epidural anaesthesia. A Biopac SS4LA pulse plethysmograph transducer was used for photoplethysmography recording, and the device was placed on the first toe of the right leg. The first standard lead of the electrocardiogram was simultaneously measured with the finger photoplethysmography. First measurement was done before the administration of epidural anaesthesia, and second measurement was done 25 minutes post administration of epidural anaesthesia.
Results: The area under the curve of the finger photoplethysmography statistically significantly increased 25 minutes after administration of epidural anaesthesia compared with the first measurement (p=0.0001). The amplitude of the finger photoplethysmography as well as the pulse transit time also statistically significantly increased after administration of epidural anaesthesia.
Conclusion: The area under the curve reflects the changes in sympathetic activity after epidural anaesthesia below the block level. It can be used for the detection of the degree of sympathetic block and, respectively, for epidural block success. Future prospects include detection of sympathetic block cessation as an indicator for discharge from the awakening room and beginning of patient verticalisation.

Keywords: Finger photoplethysmography, epidural anaesthesia, area under the curve, sympathetic blockade


Slobodan Mihaljevic, Milenko Bevanda, Kresimir Reiner, Krunoslav Sporcic, Ljiljana Mihaljevic, Marko Cacic. Area Under the Curve of Finger Photoplethysmography as an Evaluation Measure for Sympathetic Activity During Lumbar Epidural Anaesthesia. Turk J Anaesthesiol Reanim. 2018; 46(2): 147-150

Corresponding Author: Kresimir Reiner, Croatia


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