Stress
Conditions
Keywords
transcutaneous electrical acupoint stimulation, stress response
Brief summary
Elderly patients have an increased risk of stress responses during extubation after general anaesthesia for an elective supratentorial craniotomy. How to decrease the stress responses during extubation after general anaesthesia remains challenging for the anaesthesiologist. In this study, we aimed to investigate whether transcutaneous electrical acupoint stimulation (TEAS) might decrease the stress responses and improve the quality of recovery in the elderly patients who underwent elective supratentorial craniotomy under general anaesthesia.
Detailed description
A total of 100 elderly patients scheduled for elective supratentorial craniotomy under propofol-remifentanil total intravenous anaesthesia were randomly divided to either TEAS group (received stimulation at LI4, PC6, LU7, LU5, LI18 and ST9 acupoints, 2/10Hz, 6-15 mA) or Sham group (received no stimulation). The primary outcomes were the haemodynamic parameters and plasma concentrations of epinephrine (E), norepinephrine (NE) and cortisol (Cor). The secondary outcomes were the consumption of remifentanil and propofol, the time from discontinuation of anesthetics to extubation and reorientation, extubation quality score, the quality of postoperative recovery and postoperative complications.
Interventions
DEVICEHwato Electronic Acupuncture Treatment Instrument
Thirty minutes prior to the induction of anaesthesia, the patients in the TEAS group started to receive TEAS by a stimulator (Hwato Electronic Acupuncture Treatment Instrument, model No.: SDZ-II, Suzhou Medical Appliances Co., Ltd., Suzhou, China) to the right hand, forearm and neck by an experienced acupuncturist at the Hegu (LI4), Neiguan (PC6), Lieque (LU7), Chize (LU5), Futu (LI18) and Renying (ST9) acupoints. TEAS was peformed with an alternate dense-disperse frequency of 2 and10 Hz ( 2 Hz for 10 s and 10 Hz for 5 s). The optimal intensity ranged from 6-15 mA, The stimulus continued until 5 min before the end of surgery.
DEVICEPlacebo
The patients in the Sham group were also connected to the apparatus, but electronic stimulation was not applied.
Sponsors
Shengjing Hospital
Study design
Allocation
RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
60 Years to 70 Years
Healthy volunteers
Yes
Inclusion criteria
* ASA Ⅱ～Ⅲ * aged 60-70years * scheduled for elective supratentorial craniotomy under general anaesthesia
Exclusion criteria
* past or current history of cardiovascular and/or cerebrovascular diseases * diabetes * pre-existing liver, lung or kidney dysfunction * psychiatric disorders * potentially difficult airway * previous acupuncture treatment * infection at the stimulus sites
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in cortisol | Before the onset of TEAS,prior to induction, at the end of surgery, immediately after extubation, and 5 and 10 min after extubation | Cortisol was recorded before the onset of TEAS,prior to induction, at the end of surgery, immediately after extubation, and 5 and 10 min after extubation |
| Change in Non-invasive arterial blood pressure | Before the onset of TEAS,prior to induction, at the end of surgery, immediately after extubation, and 5 and 10 min after extubation | Non-invasive arterial blood pressure was recorded before the onset of TEAS,prior to induction, at the end of surgery, immediately after extubation, and 5 and 10 min after extubation |
| Change in plasma concentrations of epinephrine | Before the onset of TEAS,prior to induction, at the end of surgery, immediately after extubation, and 5 and 10 min after extubation | plasma concentrations of epinephrine was recorded before the onset of TEAS,prior to induction, at the end of surgery, immediately after extubation, and 5 and 10 min after extubation |
| Change in mean arterial blood pressure | Before the onset of TEAS,prior to induction, at the end of surgery, immediately after extubation, and 5 and 10 min after extubation | Mean arterial blood pressure was recorded before the onset of TEAS,prior to induction, at the end of surgery, immediately after extubation, and 5 and 10 min after extubation |
| Change in heart rate | Before the onset of TEAS,prior to induction, at the end of surgery, immediately after extubation, and 5 and 10 min after extubation | Heart rate was recorded before the onset of TEAS,prior to induction, at the end of surgery, immediately after extubation, and 5 and 10 min after extubation |
| Change in norepinephrine | Before the onset of TEAS,prior to induction, at the end of surgery, immediately after extubation, and 5 and 10 min after extubation | Norepinephrine was recorded before the onset of TEAS,prior to induction, at the end of surgery, immediately after extubation, and 5 and 10 min after extubation |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative quality of recovery assessed by Quality of Recovery-40 questionnaire(QoR-40) | From discontinuation of anaesthetic drugs to 24 h after surgery | — |
| the time to extubation,the time to reorientation | From discontinuation of anaesthetic drugs to 24 h after surgery | — |
| the quality of extubation was evaluated by a 5-point Extubation Quality Score | From discontinuation of anaesthetic drugs to 24 h after surgery | — |
| The total amount of remifentanil that used throughout the surgery | From discontinuation of anaesthetic drugs to 24 h after surgery | — |
| The total amount of propofol that used throughout the surgery | From discontinuation of anaesthetic drugs to 24 h after surgery | — |
| Postoperative complications,like cough,agitation,nausea and vomiting | From discontinuation of anaesthetic drugs to 24 h after surgery | Cough was assessed using a four-point scale；Agitation was evaluated using the Ricker Sedation-Agitation Scale；Nausea was defined as the patient complained of an unpleasant sensation with the urgency to vomit. Vomiting was defined as the forceful expulsion of gastric contents from the patient's mouth. |
Countries
China
Outcome results
None listed