Autonomic nervous system state: the effect of general anaesthesia and bilateral tonsillectomy after unilateral infiltration of lidocaine† M.P.J. Paloheimo,

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Autonomic nervous system state: the effect of general anaesthesia and bilateral tonsillectomy after unilateral infiltration of lidocaine† M.P.J. Paloheimo, S. Sahanne, K.H. Uutela British Journal of Anaesthesia Volume 104, Issue 5, Pages 587-595 (May 2010) DOI: 10.1093/bja/aeq065 Copyright © 2010 The Author(s) Terms and Conditions

Fig 1 Numeric values of ANSS are shown for various combinations of PPGAs and pulse intervals. ANSS data from Figure 4 are also depicted as an example of ANSdot behaviour during laryngoscopy and tracheal intubation. British Journal of Anaesthesia 2010 104, 587-595DOI: (10.1093/bja/aeq065) Copyright © 2010 The Author(s) Terms and Conditions

Fig 2 Finger temperatures after induction of anaesthesia (state entropy decreases <30 at time zero) are depicted in the upper curves. The lower curves denote the corresponding PPGAs. Note that fluctuations of PPGA during laryngoscopies and tracheal intubations are not reflected in finger temperatures. British Journal of Anaesthesia 2010 104, 587-595DOI: (10.1093/bja/aeq065) Copyright © 2010 The Author(s) Terms and Conditions

Fig 3 Laryngoscopy and tracheal intubation caused statistically significant responses during 1 min (open symbols) after starting laryngoscopy at 0 s (Table 1). British Journal of Anaesthesia 2010 104, 587-595DOI: (10.1093/bja/aeq065) Copyright © 2010 The Author(s) Terms and Conditions

Fig 4 Beat-to-beat values of the ANSS in one patient during laryngoscopy (vertical line) and intubation after six beats. Vagal slowing of HR (increase in interval) is associated with four larger pulse amplitudes until sympathetic arousal causes a decrease in pulse amplitudes and intervals. British Journal of Anaesthesia 2010 104, 587-595DOI: (10.1093/bja/aeq065) Copyright © 2010 The Author(s) Terms and Conditions

Fig 5 Changes in 10 s means of peak-to-peak pulse intervals (P–Pint), PPGA, autonomic nervous system states (ANSS=P–Pint×PPGA), autonomic nervous system state indexes [ANSSI=100−(ANSS/ANSSmax)×90, ANSSmax is the largest ANSS value in each patient] and SPIs during operations on lidocaine- and saline-infiltrated tonsils. The data are normalized to the start of tonsillectomies (0 s). For statistical inference of 5 min operative data, see Table 2. British Journal of Anaesthesia 2010 104, 587-595DOI: (10.1093/bja/aeq065) Copyright © 2010 The Author(s) Terms and Conditions