Routine intra-operative assessment of pain and/or depth of anaesthesia by nurse anaesthetists in clinical practice

Patient safety and comfort during general anaesthesia and surgery are to a considerable extent dependent on the capability of anaesthesia personnel to interpret directly monitored as well as indirect clinical signs of pain an d/or depth of anaesthesia. The aim of the present study was to evaluate how nurse anaesthetists in the ir clinical routine work assess and interpret intra-operative responses evo ked by pain stimuli and/or insufficient depth of anaesthesia. A questionnaire was designed to assess the perceived relevance and validity of cardiovascular, respiratory, mucocutaneous, eye-associated, and muscula r responses for routine assessment of intra-operative pain and/or insuffici ent depth of anaesthesia in patients undergoing surgery under general anaes thesia. Data were obtained from 223 nurse anaesthetists working at nine different u niversity anaesthesia departments in Sweden. A number of significant indicators for pain and depth of anaesthesia could be identified for spontaneously breathing as well as for mechanically venti lated patients. No variable was considered entirely specific for either int ra-operative pain or depth of anaesthesia. Changes in breathing rate/volume , central haemodynamics (BP, HR), lacrimation, and presence of moist and st icky skin were given higher score values as indicators of pain than as indi cators of depth of anaesthesia. Occurrence of grimaces, attempted movements , and presence of non-centred pupils were variables considered more indicat ive of insufficient depth of anaesthesia than intra-operative pain. In conclusion, it is obvious from the present data that indirect physiologi cal signs of intra-operative pain and depth of anaesthesia are still consid ered of importance by Swedish anaesthesia nurses in the anaesthetic managem ent of surgical patients.