Effect of pain on autonomic nervous system indices derived from photoplethysmography in healthy volunteers

Hamunen, Katri; Kontinen, Vesa K.; Hakala, Elina; Talke, Pekka; Paloheimo, Markku; Kalso, Eija

doi:10.1093/bja/aes001

Cited by 75 publications

(68 citation statements)

References 12 publications

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“…This result possibly leads to the establishment of a positive correlation between pain and parasympathetic inhibition and so a sympathetic dominance, also described in literature [35].…”

Section: Discussionsupporting

confidence: 57%

Heart Rate Variability in Children Submitted to Surgery

Silva¹,

Pinheiro²,

Almeida³

2016

J Anesth Clin Res

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Objective: Heart Rate Variability (HRV) is known to reflect the sympathetic/parasympathetic interaction on several physiological and pathological conditions such as the cardiac activity responsiveness to physiological and environmental stimuli. Therefore, it has been widely used to assess nervous autonomic fluctuations and their influence on sinus node. Studies on children have demonstrated the correlation between HRV and different parameters like age, gender, physical activity and autonomic diseases whereas little evidence exists of the effects of surgery and residual anesthesic drugs on HRV. The aim of this study was to define the possible role of minor surgery in HRV in healthy children.Design: Observational prospective cohort study.Setting: Pediatric Surgery Department of a tertiary, university-affiliated hospital.Patients: 47 healthy children who were scheduled for elective minor surgery.Measurements and Main Results: HRV measurements of 10 to 15 minutes were obtained before and after surgery, using a Holter recorder and the BioSigBrowser ® software. Results showed significant differences in HRV time domain indices before and after surgery in younger patients and in frequency domain in the older ones. They also demonstrated decreased HRV indices until one hour after being submitted to surgery in both time domain and LF parameters, reflecting a parasympathetic withdrawal and sympathetic predominance. Differences were also found when analyzing other variables such as anesthetic drugs. Conclusion:This study demonstrated that surgery has impact on Autonomic Nervous System function in healthy children but, independently of anesthetic drugs, type of surgery, age and existence of pain 60 minutes after surgery no difference in HRV measures was found and autonomic homeostasis was re-established. However, further investigation in this area is required in order to a better support of the role of HRV monitoring on early prognosis prediction and risk stratification in the surgical context.

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“…This result possibly leads to the establishment of a positive correlation between pain and parasympathetic inhibition and so a sympathetic dominance, also described in literature [35].…”

Section: Discussionsupporting

confidence: 57%

Heart Rate Variability in Children Submitted to Surgery

Silva¹,

Pinheiro²,

Almeida³

2016

J Anesth Clin Res

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“…Pain Matcher ® has been validated when assessing post-operative pain after gynaecological surgery [25] and for predicting pain after caesarean section [26]. Our cold pressor test was not identical with that of Pickering's, but it was still validated [22,23], and these small differences do not explain the different results. Paracetamol concentrations vary after oral and intravenous administration, but it is curious that we could not demonstrate any analgesic action of paracetamol after 2 g intravenously, whereas Pickering could after 1 g perorally.…”

Section: Discussionmentioning

confidence: 86%

“…At the beginning of the study session, we identified the temperature at which the volunteer reported moderate pain (4-6 on a numeric rating scale, NRS from 0 to 10) by increasing the test temperature by 2°at 6-sec. intervals from 32 to 48°C, which has been shown to induce detectable pain [22]. This target temperature served in the following tests as the volunteer's individual heat stimulus, and the sensation was assessed on NRS 0-10.…”

Section: Methodsmentioning

confidence: 99%

The Effect of Paracetamol and Tropisetron on Pain: Experimental Studies and a Review of Published Data

Tiippana

Hamunen

Kontinen

et al. 2012

Basic Clin Pharma Tox

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Experimental studies suggest that paracetamol-induced analgesia is mediated via central serotonergic pathways and attenuated by 5-HT3-antagonists. However, clinical studies do not support this, and 5-HT3-antagonists are expected to reduce pain by blocking the descending pronociceptive pathway. The current project tested whether tropisetron attenuates analgesia by paracetamol. Two randomized, double-blind, crossover studies with 18 healthy male volunteers in each were performed. Pain stimuli were cold water immersion (cold pressor test), contact heat pain (study 1) and electrical stimulation (study 2). In both studies, tropisetron 5 mg i.v. or saline was administered, followed by paracetamol 2 g i.v. 30 min. later. Individual changes in heat and cold pain intensity, cold pain tolerance and unpleasantness were recorded. The same thresholds were also expressed as scores (% of the individual score at baseline). Additionally, previously published findings on the effects of paracetamol and its interaction with 5HT3-antagonists in human experimental pain models were reviewed. After calculation of the sensory and pain scores (%), tropisetron seemed to amplify the analgesic action of paracetamol. Paracetamol 2 g i.v. did not show any statistically significant analgesia in thermal tests (study 1), or differences in sensory, pain detection or moderate pain thresholds of the electrical stimulus (study 2). As paracetamol did not have a measurable analgesic effect in these tests, no conclusions can be drawn about the interaction between paracetamol and tropisetron. However, tropisetron may have an analgesic effect of its own. Clinicians should not avoid using these drugs together, unless larger clinical studies indicate otherwise.

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“…[2–4] SPI has been presented to correlate with both surgical stimuli and analgesic dosing, and, compared with standard evaluation of clinical parameters during total intravenous anesthesia (TIVA), and consequently, SPI has been demonstrated to be more predictable for measuring autonomic responses to nociceptive stimuli and providing effective analgesia. [5–7] There are several reports about the clinical effectiveness of SPI on titration of remifentanil and sufentanil during anesthesia, [5,6,8] but no such report about oxycodone.…”

Section: Introductionmentioning

confidence: 99%

Comparison of relative oxycodone consumption in surgical pleth index-guided analgesia versus conventional analgesia during sevoflurane anesthesia

et al. 2016

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Background:The surgical pleth index (SPI) is proposed for titration of analgesic drugs during general anesthesia. Several reports have investigated the effect of SPI on the consumption of opioids including remifentanil, fentanyl, and sufentanil during anesthesia, but there are no reports about oxycodone. We aimed to investigate intravenous oxycodone consumption between SPI-guided analgesia and conventional analgesia practices during sevoflurane anesthesia in patients undergoing thyroidectomy.Methods:Forty-five patients undergoing elective thyroidectomy were randomly assigned to an SPI group (SPI-guided analgesia group, n = 23) or a control group (conventional analgesia group, n = 22). Anesthesia was maintained with sevoflurane to achieve bispectral index values between 40 and 60. In the SPI group, oxycodone 1 mg was administered intravenously at SPI values over 50; in the control group, oxycodone 1 mg was administered intravenously at the occurrence of tachycardia or hypertension event. Intraoperative oxycodone consumption and extubation time were recorded. The number of hemodynamic and somatic movement events was recorded, as were postoperative pain and recovery scores.Results:Patients’ characteristics were comparable between the groups. Intraoperative oxycodone consumption in the SPI group was significantly lower than the control group (3.5 ± 2.4 vs 5.1 ± 2.4 mg; P = 0.012). Extubation time was significantly shorter in the SPI group (10.6 ± 3.5 vs 13.4 ± 4.6 min; P = 0.026). Hemodynamic and somatic movement events during anesthesia were comparable between the groups, as were numeric rating scales for pain and modified Aldrete scores at postanesthesia care unit.Conclusions:SPI-guided analgesia reduces intravenous oxycodone consumption and extubation time compared with conventional analgesia based on clinical parameters during sevoflurane anesthesia in patients undergoing thyroidectomy.

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Effect of pain on autonomic nervous system indices derived from photoplethysmography in healthy volunteers

Abstract: All three thermal stimuli produced a significant change in photoplethysmograph-derived parameters. All photoplethysmograph-derived parameters appear to be suitable to study autonomic nervous system activation.

Cited by 75 publications

References 12 publications

Heart Rate Variability in Children Submitted to Surgery

Heart Rate Variability in Children Submitted to Surgery

The Effect of Paracetamol and Tropisetron on Pain: Experimental Studies and a Review of Published Data

Comparison of relative oxycodone consumption in surgical pleth index-guided analgesia versus conventional analgesia during sevoflurane anesthesia

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