Effect site concentrations of remifentanil and pupil response to noxious stimulation

Barvais, Luc; Engelman, Edgard; Eba, J.M.; Coussaert, Edouard; Cantraine, Francis; Kenny, G. N. C.

doi:10.1093/bja/aeg178

Cited by 135 publications

(88 citation statements)

References 19 publications

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“…Tetanic stimulation obtained with a commonly available myorelaxation monitor has been used by many authors in order to get an ANS reaction to a reproducible nociceptive stimulus [19,20]. The reaction of the ANS to a tetanic stimulation is fast, and can be measured easily with the ANI, provided that the baseline signal is stable and that this stimulus is the only one influencing the ANS at that time.…”

Section: Discussionmentioning

confidence: 99%

Variations of the analgesia nociception index during general anaesthesia for laparoscopic abdominal surgery

Jeanne

Clement

Jonckheere

et al. 2012

J Clin Monit Comput

157

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The analgesia nociception index (ANI) is an online heart rate variability analysis proposed for assessment of the antinociception/nociception balance. In this observational study, we compared ANI with heart rate (HR) and systolic blood pressure (SBP) during various noxious stimuli in anaesthetized patients. 15 adult patients undergoing laparoscopic appendectomy or cholecystectomy were studied. Patients received target controlled infusions of propofol (adjusted to maintain the Bispectral index in the range [40-60]) and remifentanil (with target increase in case of haemodynamic reactivity [increase in HR and/or SBP >20% of baseline]), and cisatracurium. Medical staff was blind to the ANI monitor. ANI and haemodynamic data were recorded at predefined times before and during surgery, including tetanic stimulation of the ulnar nerve before start of surgery. Anaesthesia induction decreased HR and SBP, while high ANI values (88 [17]) were recorded, indicating parasympathetic predominance. In 10 out of 11 patients, tetanic stimulation led to a transient (<5 min) decrease in ANI to 48 (40) whereas HR and SBP did not change. After start of surgery, ANI decreased to 60 (39) and decreased further to 50 (15) after the pneumoperitoneum was inflated, while there was no significant change in HR or SBP. When haemodynamic reactivity occurred, ANI had further decreased to 40 (15). After completion of surgery, ANI returned to 90 (34). ANI seems more sensitive than HR and SBP to moderate nociceptive stimuli in propofol-anaesthetized patients. Whether ANI monitoring may allow preventing haemodynamic reactivity to noxious stimuli remains to be demonstrated.

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Section: Discussionmentioning

confidence: 99%

Variations of the analgesia nociception index during general anaesthesia for laparoscopic abdominal surgery

Jeanne

Clement

Jonckheere

et al. 2012

J Clin Monit Comput

157

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“…Opioids mediate pupil diameter under general anaesthesia by E.W. nucleus disinhibition, resulting in miosis, and depress PDR in a dose‐dependent manner 23. To date, the mechanisms of blocking this pupil reflex are not completely understood.…”

Section: Discussionmentioning

confidence: 99%

Pain assessment by pupil dilation reflex in response to noxious stimulation in anaesthetized adults

Wildemeersch

Peeters

Saldien

et al. 2018

Acta Anaesthesiol Scand

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BackgroundIn response to noxious stimulation, pupillary dilation reflex (PDR) occurs even in anaesthetized patients. The aim of the study was to evaluate the ability of pupillometry with an automated increasing stimulus intensity to monitor intraoperative opioid administration.MethodsThirty‐four patients undergoing elective surgery were enrolled. Induction by propofol anaesthesia was increased progressively until the sedation depth criteria (SeD) were attained. Subsequently, a first dynamic pupil measurement was performed by applying standardized nociceptive stimulation (SNS). A second PDR evaluation was performed when remifentanil reached a target effect‐site concentration. Automated infrared pupillometry was used to determine PDR during nociceptive stimulations generating a unique pupillary pain index (PPI). Vital signs were measured.ResultsAfter opioid administration, anaesthetized patients required a higher stimulation intensity (57.43 mA vs 32.29 mA, P < .0005). Pupil variation in response to the nociceptive stimulations was significantly reduced after opioid administration (8 mm vs 28 mm, P < .0005). The PPI score decreased after analgesic treatment (8 vs 2, P < .0005), corresponding to a 30% decrease. The elicitation of PDR by nociceptive stimulation was performed without changes in vital signs before (HR 76 vs 74/min, P = .09; SBP 123 vs 113 mm Hg, P = .001) and after opioid administration (HR 63 vs 62/min, P = .4; SBP 98.66 vs 93.77 mm Hg, P = .032).ConclusionsDuring propofol anaesthesia, pupillometry with the possibility of low‐intensity standardized noxious stimulation via PPI protocol can be used for PDR assessment in response to remifentanil administration.

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“…Combinations of previous methods have also been described as potential indicators of nociceptive response as described by Schneider [14] or Ben-Israel [15]. Changes in pupil size [16,17] or other HRV derived parameters studying parasympathetic activity [18] in response to opioid concentrations or noxious stimulation have also been proposed as methods to assess the level of analgesia in surgical patients.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the qCON and qNOX indices for the assessment of unconsciousness level and noxious stimulation response during surgery

Melia¹,

Gabarron²,

Agustí

et al. 2016

J Clin Monit Comput

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Purpose. The objective of this work is to compare the behavior of two electroencephalogram (EEG) based indices after drug induction and during recovery of consciousness.Methods. Data was recorded from 140 patients scheduled for general anaesthesia with a combination of propofol and remifentanil. The qCON 2000 monitor (Quantium Medical, Barcelona, Spain) was used to calculate the qCON and qNOX. The fall times and the rise times were defined at the start and at the end of the surgery. Loss of response to verbal command and loss of eye-lash reflex were assessed during the transition from awake to anesthetized, defining the state of loss of consciousness (LOC). Movement as a response to laryngeal mask (LMA) insertion was interpreted as the response to the nociceptive stimuli. The patients were classified as movers or non-movers. The values of qCON and qNOX were statistically compared. Conclusion.The indices qCON and qNOX were able to detect differences between the times of actions of hypnotic and analgesic agents. The qCON showed faster decrease during induction while the qNOX showed a faster increase during recovery.

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Effect site concentrations of remifentanil and pupil response to noxious stimulation

Abstract: During propofol TCI in healthy patients, the decrease in pupil response to a painful stimulus is a better measurement of the progressive increase of remifentanil Ce(T) up to 5 ng ml(-1) than haemodynamic or BIS measurements.

Cited by 135 publications

References 19 publications

Variations of the analgesia nociception index during general anaesthesia for laparoscopic abdominal surgery

Variations of the analgesia nociception index during general anaesthesia for laparoscopic abdominal surgery

Pain assessment by pupil dilation reflex in response to noxious stimulation in anaesthetized adults

Comparison of the qCON and qNOX indices for the assessment of unconsciousness level and noxious stimulation response during surgery

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