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Canadian Journal of Anesthesia 48:713-714 (2001)
© Canadian Anesthesiologists' Society, 2001

Correspondence

Wrist actigraphy in anesthesia

Avi A. Weinbroom , MD, Ron Ben-Abraham, MD and Jacob Zomer, BSC

Tel Aviv, Israel

To the Editor:

Intraoperative assessment of sedation/awakening is imprecise, and drug administration can, consequently, be either too little or too much. Changes in respiratory, hemodynamic and muscle tone do not appear instantaneously during induction and emergence from general anesthesia when their instant recognition is vital, especially after mishaps. End-tidal CO2 and pulse oxymetry are secondary events, the recordings of which appear 15-30 sec after they have changed. Direct arterial pressure monitoring follows cardiovascular alterations rapidly, but is rarely used in healthy patients. Continuous muscular status monitoring, especially during induction, intubation and awakening, would be invaluable but has not been utilized routinely in the anesthetic setting.

An electronic wrist actigraph (Figure 1Go, Ambulatory Monitoring Inc., Ardsley, NY, USA)1 was compared to conventional clinical measurements and the anesthesiologist=s observations during anesthesia/sedation. It senses and records baseline tone patterns and later modifications, including even the slightest limb movements, and enables data storage.2



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  		FIGURE 1 Wrist actigraph.

 
Actigrams were correlated to corresponding clinical vital signs (Figure 2A-DGo). Actigraphy-demonstrated on- ward activity was more than four times higher than after premedication. Shortly after midazolam (3-6 mg) or propofol (25-75 mg) iv administration, limb movement dropped to baseline levels or below. These changes appeared more than three minutes before non-invasive blood pressure decreased and more than one minute before decreases in heart and respiratory rates. The anesthesiologist identified pain more than two to four minutes and awakening more than one minute after they had been detected actigraphically.



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  		FIGURE 2 Actigrams and vital signs of patients undergoing surgery under monitored (epidural/spinal) sedation (A, B) and general anesthesia (C, D). Movement occurred during surgery in patient A. Note that the visible changes in the actigrams preceded equivalent changes in all other vital signs in all patients.

MDZ=midazolam; PFL=propofol; ISO=isoflurane; FLM=flumazenil; units: activity=arbitrary units; blood pressure=mmHg; heart rate=beats@minB1; SpO2 =%; respiration rate=breaths@minB1.

 
On-line actigraphy appears to supplement conventional monitoring with more rapid sedation/awakening information potentially bestowing greater patient safety.

References

1 Sadeh A, Lavie P, Scher A, Tirosh E, Epstein R. Actigraphic home-monitoring sleep-disturbed and control infants and young children: a new method for pediatric assessment of sleep-wake patterns. Pediatrics 1991; 87: 494–9.[Abstract/Free Full Text]

2 Middlekoop HAM. Actigraphic Assessment of Sleep and Sleep Disorders. Delft: Eburon Publishers, 1994.





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