AUTONOMIC NERVOUS SYSTEM MONITORING TO EVALUATE SURGICAL STRESS: EFFECTS OF LIDOCAINE INFILTRATION DURING TONSILLECTOMY
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Keywords
Autonomic nervous system (ANS), Plethysmography, Anaesthesia monitoring, Surgical nociception, Peripheral perfusion.
Abstract
This research compared autonomic nervous system (ANS) responses to surgical stress in tonsillectomy and determined the influence of pre-incisional infiltration of lidocaine. Intraoperative monitoring of 23 adult patients (ASA I2) undergoing elective bilateral tonsillectomy assessed plethysmography based indices, heart rate (HR), pulse to pulse interval (PPI), plethysmographic pulse amplitude (PPGA), autonomic nervous system state (ANSS), autonomic nervous system state index (ANSSI), Surgical Pleth Index (SPI) and entropy measures. Laryngoscopy stimulated and tracheal intubation elicited noticeable sympathetic response indicated by augmented HR, diminished PPI and PPGA, as well as increased SPI. Tonsils loaded with lidocaine showed lower sympathetic responses as demonstrated by lower HR, extended PPI, increased PPGA, reduced ANSS/ANSSI, and reduced SPI than saline-treated sites, showing better nociceptive suppression. The value of entropy was similar across groups indicating the same hypnotic depth. These results indicate the value of ANS-based, non-invasive monitoring in quantifying nociceptionantinociception balance and that local lidocaine infiltration reduces autonomic responses of stress during tonsillectomy, which may lead to enhanced intraoperative physiological stability.
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Gayathri S
MS (ENT), Assistant Professor, Department of Ear, Nose & Throat (ENT), ESIC Medical College & PGIMSR,
K.K. Nagar, Chennai – 6000078
