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Electromyographic assessment of blink reflex throughout the transition from responsiveness to unresponsiveness during induction with propofol and remifentanil

2020-10-01Journal article Open access
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dc.contributor.authorFerreira, Ana Isabel Leitão
dc.contributor.authorVide, Sérgio
dc.contributor.authorFelgueiras, João
dc.contributor.authorCardoso, Márcio
dc.contributor.authorNunes, Catarina S.
dc.contributor.authorMendes, Joaquim
dc.contributor.authorAmorim, Pedro
dc.date.accessioned2021-11-30T16:15:42Z
dc.date.available2023-10-01T00:30:21Z
dc.date.issued2020-10-01
dc.description.abstractGeneral anesthesia is a reversible drug-induced state of altered arousal characterized by loss of responsiveness due to brainstem inactivation. Precise identification of the moment in which responsiveness is lost during the induction of general anesthesia is extremely important to provide information regarding an individual's anesthetic requirements and help intraoperative drug titration. To characterize the transition from responsiveness to unresponsiveness more objectively, we studied neurophysiologic-derived parameters of electromyographic records of electrically evoked blink reflex as a means of identifying the precise moment of loss of responsiveness. Twenty-five patients received a slow infusion of propofol until loss of corneal reflex while successive blink reflexes were elicited and recorded every 6 s. The level of anesthesia was assessed using an adapted version of the Richmond Agitation-Sedation Scale. Different variables of the blink reflex components were calculated and compared to the adapted version of the Richmond Agitation-Sedation score and the estimated effect-site propofol concentration. Baselines of the blink reflex responses were similar to those in literature. After propofol infusion started, the most susceptible component of the blink reflex to propofol was R2 (EC50 = 1.358 (95% CI 1.321, 1.396) µg/mL) and the most resistant was R1 (EC50 = 3.025 (95% CI 2.960, 3.090) µg/mL). Most of the patients (24 out of 25) lost the R1 component when they were still responsive to shaking and shouting and corneal reflex could be elicited clinically (time = 102.48 ± 33.00 s). Habituation was present in R2 but not in R1. The R1 component of the blink reflex was found to have a strong correlation with the adapted version of the Richmond Agitation-Sedation Scale, with amplitude correlating better than areas (ρ = - 0.721 (0.123) versus ρ = - 0.688 (0.165)). We found a strong correlation between the R1 component with the estimated propofol effect-site concentration, with amplitude correlating better than areas (ρ = - 0.838 (0.113) versus ρ = - 0.823 (0.153)) and between the clinical scale and the propofol concentration (ρ = 0.856 (0.060)). The area and amplitude of the R1 component showed to be indicators of predicting different levels of anesthesia (Pk = 0.672 (0.183) versus Pk = 0.709 (0.134)) and these are connected to the propofol concentrations (Pk = 0.593 (0.10)). Our results suggest that electrically evoked blink reflex could be used during the induction of anesthesia as a surrogate of the Richmond Agitation-Sedation Scale to provide an objective endpoint as far as a - 4. At this point, at the moment of loss of R1, the propofol infusion may be stopped, as overshooting increases slightly the effect-site concentration afterward and eventually reaching loss of responsiveness. If the desired target is not achieved, the infusion can then be resumed.pt_PT
dc.description.sponsorshipAcknowledgements This work was supported by the Fundação para a Ciência e Tecnologia under the projects SFRH/BD/98915/2013 and FCT-UID/EMS/50022/2013.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationFerreira, A., Vide, S., Felgueiras, J. et al. Electromyographic assessment of blink reflex throughout the transition from responsiveness to unresponsiveness during induction with propofol and remifentanil. J Clin Monit Comput (2020). https://doi.org/10.1007/s10877-020-00593-wpt_PT
dc.identifier.doi10.1007/s10877-020-00593-wpt_PT
dc.identifier.eissn1573-2614
dc.identifier.issn1387-1307
dc.identifier.urihttp://hdl.handle.net/10400.2/11445
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherSpringerpt_PT
dc.relationAdvanced Consciousness Assessment for Anaesthesia
dc.subjectPersonalized anesthesiapt_PT
dc.subjectPropofolpt_PT
dc.subjectBlink reflexpt_PT
dc.subjectElectromyographypt_PT
dc.subjectLoss of responsivenesspt_PT
dc.subjectMonitoringpt_PT
dc.titleElectromyographic assessment of blink reflex throughout the transition from responsiveness to unresponsiveness during induction with propofol and remifentanilpt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.awardTitleAdvanced Consciousness Assessment for Anaesthesia
oaire.awardURIinfo:eu-repo/grantAgreement/FCT//SFRH%2FBD%2F98915%2F2013/PT
oaire.awardURIinfo:eu-repo/grantAgreement/FCT/5876/UID%2FEMS%2F50022%2F2013/PT
oaire.citation.endPage11pt_PT
oaire.citation.startPage1pt_PT
oaire.citation.titleJournal of Clinical Monitoring and Computingpt_PT
oaire.fundingStream5876
person.familyNameFerreira
person.familyNameVide
person.familyNameNunes
person.familyNameMendes
person.familyNameAmorim
person.givenNameAna
person.givenNameSérgio
person.givenNameCatarina S.
person.givenNameJoaquim
person.givenNamePedro
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person.identifier.orcid0000-0002-8357-0994
person.identifier.orcid0000-0003-4254-1879
person.identifier.orcid0000-0001-7466-4174
person.identifier.ridH-8140-2014
person.identifier.ridO-5655-2016
person.identifier.scopus-author-id57204246003
person.identifier.scopus-author-id35931916900
person.identifier.scopus-author-id55429654100
project.funder.identifierhttp://doi.org/10.13039/501100001871
project.funder.identifierhttp://doi.org/10.13039/501100001871
project.funder.nameFundação para a Ciência e a Tecnologia
project.funder.nameFundação para a Ciência e a Tecnologia
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT
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