Impact of General Anesthesia Guided by State Entropy (SE) and Response Entropy (RE) on Perioperative Stability in Elective Laparoscopic Cholecystectomy Patients—A Prospective Observational Randomized Monocentric Study

Feng

IEEE J. Transl. Eng. Health Med.

et al. 2020

Background: Some parameters have been extracted from photoplethysmography (PPG) with a good relativity with nociception, but without encouraging results in qualifying the balance of nociception-anti-nociception (NAN). The features of PPG have not been thoroughly depicted and more prospective univariate parameters deserve to be explored. The aim of this study was to investigate the ability of parameters derived from catacrotic phase of PPG to grade the level of analgesia. Methods: 45 patients with ASA I or II were randomized to receive a remifentanil effect-compartment target controlled infusion (Ce remi ) of 0, 1, or 3 ng/ml, and a propofol effect-compartment target controlled infusion to maintain an acceptable level of hypnosis with state entropy (SE) at 40~60. Laryngeal mask airway (LMA) insertion was applied as a noxious stimulus. Five diastole-related parameters, namely diastolic interval (DI), diastolic slope (DS), the minimum slope during catacrotic phase (DSmin), the interval between DSmin and its nearest trough (DTI), and area difference ratio (ADR), were extracted. Pulse beat interval (PBI) was calculated as a reference parameter. Results: LMA insertion elicited a significant variation in all parameters except ADR during Ce remi of 0 and 1 ng/ml. Compared to PBI (prediction probability ( \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{upgreek} \usepackage{mathrsfs} \setlength{\oddsidemargin}{-69pt} \begin{document} }{}$\text{P}_{\text {K}}$ \end{document} ) = 0.796), the parameters of DI, DS, and DTI presented a better consistence with the level of anti-nociceptive medication, with \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{upgreek} \usepackage{mathrsfs} \setlength{\oddsidemargin}{-69pt} \begin{document} }{}$\text{P}_{\text {K}}$ \end{document} of 0.825, 0.822, and 0.822 respectively. Conclusion: The features extracted from catacrotic phase of PPG, including DI, DS, and DTI, could provide a promising potential to qualify the balance of NAN.

Section: Discussionmentioning

confidence: 99%

Effect of Laryngeal Mask Airway Insertion on Parameters Derived From Catacrotic Phase of Photoplethysmography Under Different Concentrations of Remifentanil

Feng

IEEE J. Transl. Eng. Health Med.

et al. 2020

“…The aim of these parameters is to aid the clinician in deciding the adequate analgesia dosage for each patient. Whereas monitoring the degree of hypnosis is achieved through the direct evaluation of the EEG signals, the nociception-antinociception balance can be monitored indirectly [ 9 , 12 ] by evaluating certain variables such as the vasomotor reflex, pupillary size, the H reflex, and the hemodynamic response [ 57 , 58 ] ( Figure 1 ).…”

Section: Monitoring Techniques For the Nociception-antinociceptionmentioning

confidence: 99%

“…In order to keep up with the demand multiparametric monitoring techniques in general anesthesia, rapid adaption is needed. This would lead to shorter waiting times, less post-operatory adverse events, and an increase in patient safety [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Multiparametric Monitoring of Hypnosis and Nociception-Antinociception Balance during General Anesthesia—A New Era in Patient Safety Standards and Healthcare Management

et al. 2021

Self Cite

The development of general anesthesia techniques and anesthetic substances has opened new horizons for the expansion and improvement of surgical techniques. Nevertheless, more complex surgical procedures have brought a higher complexity and longer duration for general anesthesia, which has led to a series of adverse events such as hemodynamic instability, under- or overdosage of anesthetic drugs, and an increased number of post-anesthetic events. In order to adapt the anesthesia according to the particularities of each patient, the multimodal monitoring of these patients is highly recommended. Classically, general anesthesia monitoring consists of the analysis of vital functions and gas exchange. Multimodal monitoring refers to the concomitant monitoring of the degree of hypnosis and the nociceptive-antinociceptive balance. By titrating anesthetic drugs according to these parameters, clinical benefits can be obtained, such as hemodynamic stabilization, the reduction of awakening times, and the reduction of postoperative complications. Another important aspect is the impact on the status of inflammation and the redox balance. By minimizing inflammatory and oxidative impact, a faster recovery can be achieved that increases patient safety. The purpose of this literature review is to present the most modern multimodal monitoring techniques to discuss the particularities of each technique.

“…The aim of these parameters is to come as an aid to the clinician in deciding the adequate analgesia dosage for each patient. While monitoring the degree of hypnosis is achieved through the direct evaluation of the EEG signals, the nociception-antinociception balance can be monitored indirectly [9,12,57], by evaluating certain variables such as the vasomotor reflex, pupillary size, the H reflex, and the hemodynamic response [58] (Figure 1). Figure 1.…”

Section: Monitoring Techniques For the Nociception-antinociception Bamentioning

confidence: 99%

“…The loss of consciousness can have a number of causes, such as anesthesia, cerebral lesions or sleep. In the case of anesthesia the responses of the central nervous system are totally suppressed; the state is reversible and is an attribute of the development of modern medicine that made possible the development of modern surgery and invasive therapeutic and diagnostic techniques [9].…”

Section: Introductionmentioning

confidence: 99%

Multiparametric Monitoring of Hypnosis and Nociception-Antinociception Balance During General Anesthesia - A New Era in Patient Safety Standards and Healthcare Management

Rogobete¹,

Bedreag²,

Păpurică³

et al. 2020

Preprint

Self Cite

Worldwide, an increasing number of patients undergo complex surgeries. With the development of general anesthesia techniques and anesthetic substances, the most complex surgical techniques could be developed. In order to adapt the anesthesia according to the particularities of each patient, it is recommended the multimodal monitoring of these patients. Classically, general anesthesia monitoring consists of the analysis of vital functions and gas exchange. Multimodal monitoring refers to the concomitant monitoring of the degree of hypnosis and the nociceptive-antinociceptive balance. By titrating anesthetic drugs according to these parameters, clinical benefits can be obtained, such as hemodynamic stabilization, reduction of awakening times, reduction of post-operative complications. Also, there is an important impact on the status of inflammation and the redox balance. The purpose of this literature review is to present the most modern multimodal monitoring techniques, respectively to discuss the particularities of each technique.