Clinical Value Of Photoplethysmograph Pulse Wave And Tip Perfusion Index In Monitoring Stress Response During Anesthetic Induction

Objective: To Observe the change of Photoplethysmograph pulse wave with different doses of fentanyl during induction, To evaluate the feasibility and accuracy of Photoplethysmograph pulse wave(PPGPW) in monitoring stress response during anesthetic induction.Methods: Ninety patients ASA I or II aged 18~60 years undergoing elective surgery were enrolled in this study. Heart rate(HR), Systemic blood pressure(SBP), Diastolic blood pressure(DBP), Sp O2, the skin temperature of finger and perfusion index(PI) were recorded at following time points: into operation room(T1), 2 min after induction(T2), intubation immediate(T3), 1 min(T4) and 5 min(T5) after intubation.And the PPGPW was printed at the same time,moreover measuring its. The measurement of various parameters: photoplethysmograph pulse wave amplitude(PPGA), the front inclination angle(α1), posterior tilt angle(α2), rise time(T1), fall time(T2) and pulse beat interval(PBI). Venous blood samples were taken from 4ml to detect the levels of epinephrine(E) and norepinephrine(NE) by Elisa method in the meantime.Result: The result showed that α2, E and NE in three groups were significantly decreased at T2 and T5 as compared with the baseline at T1(P<0.05). PPGA and PI in three groups were significantly increased at T2 and T5 as compared with the baseline at T1(P<0.05). NE and α2 in group F4 and F5 were significantly increased at T3 as compared with them at T1(P<0.05), PPGA, PI in group F4 and F5 were significantly increased at T3 as compared with them at T1(P<0.05). Compared with T1, E in group F4 was increased at T3(P<0.05), but E had no significant change in group F5(P>0.05). PPGA and PI were increased at T2, T3, T4 and T5 in the group F6, E and NE were decreased at T2, T3, T4 and T5 in the group F6(P<0.01). Compared with T3, PPGA and PI were increased at T4 and T5 in the group F4 and F5, α2, E and NE were decreased at T4 and T5 in the group F4 and F5, but all of them had no significant change in group F6. PPGA and PI in group F6 were significantly higher than that of group F4 and F5 group at T3 and T4(P<0.01). E and NE in group F6 were significantly lower than that of group F4 and F5 group at T3 and T4(P<0.01). Moreover, PI was negatively correlated with plasma HR, SBP, DBP, E and NE(P<0.05), in addition, PPGA was negatively correlated with plasma E and NE(P<0.05), α2 was positively correlated with plasma HR, SBP,DBP and NE(P<0.05), t2 and PBI was negatively correlated with plasma HR, SBP, DBP, E and NE(P<0.05),PBI was negatively correlated with plasma HR, SBP, DBP, E and NE(P<0.05).Conclusion: PPGA, PI and α2 can reflect the stress reaction during the induction period of intravenous anesthesia effectively and immediately.