La dynamométrie du serrement manuel comme évaluation continue du contrôle volontaire pendant l’induction de l’anesthésie : étude observationnelle prospective.
Purpose: Response to commands is the gold standard to assess the level of consciousness during anesthesia induction but it only provides an intermittent, binary measure with low temporal resolution. To overcome these limitations, we combined the object hold method with handgrip dynamometry to contin...
| Published in: | Canadian Journal of Anaesthesia / Journal Canadien d'Anesthésie Vol. 66; no. 1; pp. 48 - 57 |
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| Main Authors: | , |
| Format: | pictorial research tables/charts Journal Article |
| Published: |
Springer Nature
Jan2019
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=133799907&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 133799907 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 0832610X 10OS jtl: Canadian Journal of Anaesthesia / Journal Canadien d'Anesthésie issn: 0832610X maglogo: N pubinfo: dt: Jan2019 vid: 66 iid: 1 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 133799907 133799907 NLM30229542 133799907 10.1007/s12630-018-1224-x NLM30229542 133799907 ppf: 48 ppct: 9 formats: tig: atl: La dynamométrie du serrement manuel comme évaluation continue du contrôle volontaire pendant l’induction de l’anesthésie : étude observationnelle prospective. aug: au: Guay, Christian S. Plourde, Gilles affil: Department of Anesthesia, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada sug: subj: Consciousness Drug Effects Dynamometry Intraoperative Monitoring Equipment and Supplies Grip Strength Physiology Propofol Administration and Dosage Anesthetics, Intravenous Administration and Dosage Male Prospective Studies Adult Female Language Tests Human Adult: 19-44 years Male Female ab: Purpose: Response to commands is the gold standard to assess the level of consciousness during anesthesia induction but it only provides an intermittent, binary measure with low temporal resolution. To overcome these limitations, we combined the object hold method with handgrip dynamometry to continuously record the force applied to hold a dynamometer as a surrogate measure of the level of consciousness during induction of anesthesia.Methods: Fourteen patients scheduled for elective lumbar surgery and 14 age-matched non-anesthetized controls were enrolled. The subjects held the dynamometer with their dominant hand for as long as possible (patients) or until told to stop (controls). After a one-minute baseline, propofol was infused (1.0 mg·kg-1·min-1) to the patient group until the subject dropped the dynamometer, which defined the object hold time. Three additional patients were also asked intermittently to squeeze the dynamometer during the propofol infusion to determine any retained ability to exert a strong grip despite any grip changes during induction.Results: The mean (standard deviation) object hold time was 115 (22) seconds after the start of the propofol infusion. There was a progressive significant linear decrease (R2 = 0.98; P < 0.001) in dynamometry-determined handgrip force starting approximately 74 seconds before object drop. Age was inversely related to the object hold time (R2 = 0.47, P < 0.01). The three additional propofol induction patients had strong intermittent grip strength despite progressive decreases in the hold force. Of the 17 patients who completed the object hold task (14 with the standard protocol and three with intermittent squeeze requests), 16 (94%; 95% confidence interval, 76 to 99%) did not respond to verbal commands after dropping the dynamometer.Conclusion: Handgrip dynamometry can be used to continuously track volitional control during induction of anesthesia while also reliably showing a gradual loss of consciousness. This method could be useful for studies investigating mechanisms of anesthesia. pubtype: Academic Journal doctype: pictorial research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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