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The Effect of Tracheal Intubation-Induced Autonomic Response on Photoplethysmography

View Article: PubMed Central - PubMed

ABSTRACT

Introduction. Intraoperative stress responses and postoperative pain can be monitored using photoplethysmography (PPG). PPG signal has two components, AC and DC. Effects of noxious stimuli-induced stress responses have not been studied on the DC component of PPG. The aim of this study was to investigate the effect of a known noxious stimulus (endotracheal intubation) on both the AC and DC components of PPG. Methods. 15 surgical patients having general anesthesia were enrolled into this clinical study. PPG was recorded electronically from a pulse oximeter. Maximum changes in the AC and DC components of the PPG and pulse rate were determined in response to endotracheal intubation from high frequency (62.5 Hz) PPG recordings. Results. Endotracheal intubation-induced autonomic stress response resulted in a significant decrease in the AC component of the PPG and an increase in pulse rate in every subject (p < 0.05 for all). The decrease in the AC component of the PPG was 50 ± 12% (p < 0.05) and the increase in pulse rate was 26 ± 10 bpm (p < 0.05). The response of the DC component was variable (p = NS). Conclusion. Endotracheal intubation-induced stress response resulted in a significant and consistent change in the AC, but not the DC component of the PPG. This trial is registered with ClinicalTrials.gov Identifier NCT03032939.

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Change (absolute values) in pulse rate (PR) and photoplethysmogram component (AC, DC, and PI) data from baseline values. Data are mean (thick line) ± SD over 60 heartbeats. Data is illustrated for 5 heartbeats before and 55 heartbeats after the beginning of the response. The red horizontal bars illustrate values that are significantly (p < 0.05) different from baseline values. Units for AC and DC are analog-to-digital converter counts (AD).
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fig2: Change (absolute values) in pulse rate (PR) and photoplethysmogram component (AC, DC, and PI) data from baseline values. Data are mean (thick line) ± SD over 60 heartbeats. Data is illustrated for 5 heartbeats before and 55 heartbeats after the beginning of the response. The red horizontal bars illustrate values that are significantly (p < 0.05) different from baseline values. Units for AC and DC are analog-to-digital converter counts (AD).

Mentions: Out of 15 subjects, 5 subjects were excluded from analysis for technical (3) and movement related artifact (2) reasons. Demographic and medication data of the remaining 10 subjects are shown in Table 1. Average time from beginning of laryngoscopy to end of intubation was 9 ± 2 seconds. AC and PI decreased and PR increased in response to endotracheal intubation in all subjects (p < 0.05 for all) (Figure 2). DC increased in 3 subjects and decreased in 7 subjects in response to endotracheal intubation (p = NS) (Figure 2).


The Effect of Tracheal Intubation-Induced Autonomic Response on Photoplethysmography
Change (absolute values) in pulse rate (PR) and photoplethysmogram component (AC, DC, and PI) data from baseline values. Data are mean (thick line) ± SD over 60 heartbeats. Data is illustrated for 5 heartbeats before and 55 heartbeats after the beginning of the response. The red horizontal bars illustrate values that are significantly (p < 0.05) different from baseline values. Units for AC and DC are analog-to-digital converter counts (AD).
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Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5392400&req=5

fig2: Change (absolute values) in pulse rate (PR) and photoplethysmogram component (AC, DC, and PI) data from baseline values. Data are mean (thick line) ± SD over 60 heartbeats. Data is illustrated for 5 heartbeats before and 55 heartbeats after the beginning of the response. The red horizontal bars illustrate values that are significantly (p < 0.05) different from baseline values. Units for AC and DC are analog-to-digital converter counts (AD).
Mentions: Out of 15 subjects, 5 subjects were excluded from analysis for technical (3) and movement related artifact (2) reasons. Demographic and medication data of the remaining 10 subjects are shown in Table 1. Average time from beginning of laryngoscopy to end of intubation was 9 ± 2 seconds. AC and PI decreased and PR increased in response to endotracheal intubation in all subjects (p < 0.05 for all) (Figure 2). DC increased in 3 subjects and decreased in 7 subjects in response to endotracheal intubation (p = NS) (Figure 2).

View Article: PubMed Central - PubMed

ABSTRACT

Introduction. Intraoperative stress responses and postoperative pain can be monitored using photoplethysmography (PPG). PPG signal has two components, AC and DC. Effects of noxious stimuli-induced stress responses have not been studied on the DC component of PPG. The aim of this study was to investigate the effect of a known noxious stimulus (endotracheal intubation) on both the AC and DC components of PPG. Methods. 15 surgical patients having general anesthesia were enrolled into this clinical study. PPG was recorded electronically from a pulse oximeter. Maximum changes in the AC and DC components of the PPG and pulse rate were determined in response to endotracheal intubation from high frequency (62.5&thinsp;Hz) PPG recordings. Results. Endotracheal intubation-induced autonomic stress response resulted in a significant decrease in the AC component of the PPG and an increase in pulse rate in every subject (p &lt; 0.05 for all). The decrease in the AC component of the PPG was 50 &plusmn; 12% (p &lt; 0.05) and the increase in pulse rate was 26 &plusmn; 10&thinsp;bpm (p &lt; 0.05). The response of the DC component was variable (p = NS). Conclusion. Endotracheal intubation-induced stress response resulted in a significant and consistent change in the AC, but not the DC component of the PPG. This trial is registered with ClinicalTrials.gov Identifier NCT03032939.

No MeSH data available.


Related in: MedlinePlus