Guiding opioid-free intravenous antinociception with the Analgesia Nociception Index: a case report

Coeckelenbergh, Sean; Estèbe, Jean-Pierre

doi:10.1016/j.bjane.2020.07.010

Cited by 3 publications

(3 citation statements)

References 9 publications

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“…Many studies have investigated the potential of nociception monitoring during general anaesthesia, but few have focused on predicting optimal antinociception 13–15,19–21 . As a general rule, these monitors are used to guide reactive algorithms (i.e.…”

Section: Discussionmentioning

confidence: 99%

“…Many studies have investigated the potential of nociception monitoring during general anaesthesia, but few have focused on predicting optimal antinociception. [13][14][15][19][20][21] As a general rule, these monitors are used to guide reactive algorithms (i.e. to increase or decrease analgesics based on the change in the monitored parameter to surgical stimuli).…”

Section: Discussionmentioning

confidence: 99%

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Predicting personalised remifentanil effect site concentration for surgical incision using the nociception level index

Perrin

Bisdorff

Saxena

et al. 2022

European Journal of Anaesthesiology

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BACKGROUNDInadequate antinociception can cause haemodynamic instability. The nociception level (NOL) index measures response to noxious stimuli, but its capacity to predict optimal antinociception is unknown.OBJECTIVETo determine if NOL index change to a tetanic stimulus in cardiac and noncardiac surgery patients could predict the required remifentanil concentration for haemodynamic stability at skin incision.DESIGNA prospective two-phase cohort study.SETTINGUniversity hospital.PATIENTSPatients undergoing remifentanil-propofol target controlled infusion (TCI) anaesthesia.INTERVENTIONSDuring the calibration phase, investigators evaluated the tetanic stimulus induced NOL index change under standardised TCI remifentanil-propofol anaesthesia during a no-touch period [bispectral index (BIS) between 40 and 60, NOL index under 15]. If the NOL index change was 20 or greater following tetanic stimulation, investigators repeated the tetanus at higher remifentanil concentrations until the response was blunted. Surgeons incised the skin at this remifentanil concentration. The investigators derived a prediction model and in the validation phase calculated, using the NOL response to a single tetanus, the required incision remifentanil concentration for the start of surgery.MAIN OUTCOMEHaemodynamic stability at incision [i.e. maximum heart rate (HR) < 20% increase from baseline, minimum HR (40 bpm) and mean arterial pressure (MAP) ± <20% of baseline].RESULTSDuring the calibration phase, no patient had hypertension. Two patients had a HR increase slightly greater than 20% (25.4 and 26.7%) within the first 2 min of surgery, but neither of these two patients had a HR above 76 bpm. Two patients were slightly hypotensive after incision (MAP 64 and 73 mmHg). During the validation phase, neither tachycardia nor hypotension occurred, but MAP increased to 21.5% above baseline for one patient.CONCLUSIONDuring a no-touch period in patients under steady-state general anaesthesia [propofol effect site concentration (Ce) required for BIS between 40 and 60], the NOL index response to a tetanic stimulus under remifentanil antinociception can be used to personalise remifentanil Ce for the start of surgery and ensure stable haemodynamics.TRIAL REGISTRATIONClinicalTrials.gov: NCT03324269

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Predicting personalised remifentanil effect site concentration for surgical incision using the nociception level index

Perrin

Bisdorff

Saxena

et al. 2022

European Journal of Anaesthesiology

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“…In such a challenging situation multidisciplinary approach seems necessary considering the surgeon, the allergist, and the anesthesiologist with preanesthetic and pre-operative discussion about the perioperative protocol. An opioid-free anaesthesia (OFA) strategy appears to be an effective and safe solution, using fewer allergens drugs, and monitoring possibilities like nociception level index (NOL), which showed good sensitivity and specificity [1][2][3]. NOL monitor uses an algorithm based on the heart rate, delta heart rate, plethysmography pulse wave, skin temperature, and conductance.…”

Section: Introductionmentioning

confidence: 99%

Anaesthesia of a Patient Allergic to Multiple-Anaesthesia Drugs: A Case Report

Saleh¹,

Bensalah²,

Khene³

et al. 2021

SCR

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Anaesthesia of multiple drug allergic patients may be very challenging. Especially with a patient showing allergic signs for multiple main anaesthesia drugs and scheduled for laparoscopic robot-assisted surgery. We report the case of a 65-year-old man. The systemic allergic screenings concluded with rocuronium, atracurium, cisatracurium, propofol, chlorhexidine, latex and betalactamine contraindications. Sufentanil to be used with extreme precautions. General anaesthesia was performed with an OFA protocol. Muscle relaxation was obtained by deep sedation. A close collaboration with the surgeons made it possible to carry out the procedure with a perfect control of the postoperative pain.

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Intraoperative Monitoring of the Obese Patient Undergoing Surgery: A Narrative Review

et al. 2021

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With the increasing prevalence of obesity in the population, anaesthetists must confidently manage both the pathophysiological and technical challenges presented in bariatric and non-bariatric surgery. The intraoperative period represents an important opportunity to optimise and mitigate risk. However, there is little formal guidance on what intraoperative monitoring techniques should be used in this population. This narrative review collates the existing evidence for intraoperative monitoring devices in the obese patients. Although a number of non-invasive blood pressure monitors have been tested, an invasive arterial line remains the most reliable monitor if accurate, continuous monitoring is required. Goal-directed fluid therapy is recommended by clinical practice guidelines, but the methods tested to assess this had guarded applicability to the obese population. Transcutaneous carbon dioxide (CO 2 ) monitoring may offer additional benefit to standard capnography in this population. Individually titrated positive end expiratory pressure (PEEP) and recruitment manoeuvres improved intraoperative mechanics but yielded no benefit in the immediate postoperative period. Depth of anaesthesia monitoring appears to be beneficial in the perioperative period regarding recovery times and complications. Objective confirmation of reversal of neuromuscular blockade continues to be a central tenet of anaesthesia practice, particularly relevant to this group who have been characterised as an “at risk” extubation group. Where deep neuromuscular blockade is used, continuous neuromuscular blockade is suggested. Both obesity and the intraoperative context represent somewhat unstable search terms, as the clinical implications of the obesity phenotype are not uniform, and the type and urgency of surgery have significant impact on the intraoperative setting. This renders the generation of summary conclusions around what intraoperative monitoring techniques are suitable in this population highly challenging.

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Guiding opioid-free intravenous antinociception with the Analgesia Nociception Index: a case report

Cited by 3 publications

References 9 publications

Predicting personalised remifentanil effect site concentration for surgical incision using the nociception level index

Predicting personalised remifentanil effect site concentration for surgical incision using the nociception level index

Anaesthesia of a Patient Allergic to Multiple-Anaesthesia Drugs: A Case Report

Intraoperative Monitoring of the Obese Patient Undergoing Surgery: A Narrative Review

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