A new arterial mechanical property indicator reflecting differences in invasive stimulus intensity induced by alteration of remifentanil concentration during laryngoscopy.

BACKGROUND: Reliable analgesia monitoring is not available for general anaesthesia cases. In 2003, we introduced a method to characterise arterial mechanical properties, which we termed arterial stiffness (K). However, it is unclear whether differences in K actually indicate changes in the intensity of a noxious stimulus. Thus, we examined the relationship between stress intensity and the value of K.

METHODS: Thirty patients under general anesthesia were randomly divided into two remifentanil concentration groups (2 and 6 ng/mL). After a steady concentration of remifentanil was achieved for at least 3 minutes, laryngoscopy was performed. After completion of laryngoscopy, once the K value returned to near-baseline, laryngoscopy with endotracheal intubation was performed, and the value of K after the procedure was recorded and analyzed.

RESULTS: In total, data were obtained for 28 of 30 patients. The values of K before the laryngoscopy were not significantly different between the groups (2 ng/mL group: 13.1 [8.5-33.1] mmHg/%; 6 ng/mL group: 11.6 [4.3-31.4] mmHg/%; P=0.53). After laryngoscopy, K was approximately 2 times greater in the 2 ng/mL group than in the 6 ng/mL group (39.0 [13.6-115.9] mmHg/% vs. 19.0 [5.5-85.1] mmHg/%, P=0.02). After intubation also, K was approximately 2 times greater in the 2 ng/mL group (52.0 [27.7-122.0] mmHg/% vs. 24.3 [7.2-94.9] mmHg/%, P=0.04).

CONCLUSIONS: The value for arterial stiffness (K) non-proportionally changes in response to stimulus intensity; therefore, it has the potential to be used as an indicator of nociceptive stimulation intensity.