SKNA According to Different Anesthetics
Conditions
Keywords
skin sympathetic nerve activity, anesthetics
Brief summary
Skin sympathetic nerve activity (SKNA) has recently been discovered from the electrocardiogram obtained from healthy volunteers. The raw physiologic electric signal from electrodes placed on the skin was reprocessed through filtering and integration using software to produce the SKNA signal. However, no study has yet provided knowledge on the effect of anesthetics on SKNA during general anesthesia.
Detailed description
The most commonly used anesthetic techniques during general anesthesia are the total intravenous anesthesia (TIVA) and anesthesia using inhalants such as sevoflurane or desflurane. For TIVA, the combination of propofol and remifentanil has been used and remifentanil is known for increasing vagal tone and inhibiting sympathetic nervous system as other opioids do. Sevoflurane is presumed to have no effect on parasympathetic or sympathetic tone. On the other hand, desflurane induces tachycardia and is noted for activating sympathetic activity. Previous studies on sympathetic nervous activity according to different anesthetics did not directly measure sympathetic tone but have relied on indirect measures such as blood pressure, heart rate, and heart rate variability. In order to evaluate skin sympathetic nerve activity according to different anesthetics, we will be recruiting patients undergoing transurethral procedures, where the sympathetic tone is expected to be activated during anesthesia and surgery. The transurethral procedures consist of transurethral resection of bladder (TURB) and transurethral resection of prostate (TURP). During transurethral surgery, about 300mL of fluid is used to fill the bladder to secure surgical view and for irrigation. Bladder expansion causes sympathetic nerve activation and vasoconstriction, which will also increase SKNA signals. The purpose of this study is to measure skin sympathetic nerve activity according to different anesthetics during intraoperative events that stimulate sympathetic tone.
Interventions
Propofol intravenous continuous infusion for anesthetic induction and maintenance
DRUGRemifentanil
Remifentanil intravenous continuous infusion for anesthetic induction and maintenance
DRUGSevoflurane
Study participants receive fentanyl 1mcg/kg and propofol 1.5\ 2mg/kg for induction of general anesthesia. For maintenance of anesthesia, desflurane is used to maintain 1 age-related minimum alveolar concentration (MAC).
DRUGDesflurane
1 age-related minimum alveolar concentration (MAC) of desflurane inhalation for anesthetic maintenance
DRUGPropofol bolus injection
Propofol intravenous injection for anesthetic induction
DRUGFentanyl
Fentanyl intravenous injection for anesthetic induction
Sponsors
Seoul National University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
20 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Scheduled to undergo elective transurethral procedures under general anesthesia
Exclusion criteria
* Diagnosed with autonomic dysfunction * Current use of beta blockers * Cardiac arrhythmia * Absolute indication for either TIVA or inhalants, absolute contraindication for either TIVA or inhalants (adverse effects on either propofol or remifentanil, risk of malignant hyperthermia)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The skin sympathetic nerve activity (SKNA) presented as uV obtained via skin leads. | Intraoperative | The average intraoperative SKNA divided by average SKNA before induction of general anesthesia (T0) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percent change of SKNA | T1: 1.5 minute after use of anesthetics, T2: 1.5 minute after use of muscle relaxant, T3: 30 seconds after intubation, T4: before bladder expansion, T5: 30 seconds after bladder expansion, T6: 30 sec after start of surgery, T7: 30sec after end of surgery | Percent change of SKNA at different time points (T1-T7) compared to T0 |
Outcome results
None listed