Intraoperative Assessment of Surgical Stress Response Using Nociception Monitor under General Anesthesia and Postoperative Complications: A Narrative Review

Abstract

We present a narrative review focusing on the new role of nociception monitor in intraoperative anesthetic management. Higher invasiveness of surgery elicits a higher degree of surgical stress responses including neuroendocrine-metabolic and inflammatory-immune responses, which are associated with the occurrence of major postoperative complications. Conversely, anesthetic management mitigates these responses. Furthermore, improper attenuation of nociceptive input and related autonomic effects may induce increased stress response that may adversely influence outcome even in minimally invasive surgeries. The original role of nociception monitor, which is to assess a balance between nociception caused by surgical trauma and anti-nociception due to anesthesia, may allow an assessment of surgical stress response. The goal of this review is to inform healthcare professionals providing anesthetic management that nociception monitors may provide intraoperative data associated with surgical stress responses, and to inspire new research into the effects of nociception monitor-guided anesthesia on postoperative complications.

Effect of nociception level index‐guided intra‐operative analgesia on early postoperative pain and opioid consumption: a systematic review and meta‐analysis

“…The heterogeneity of the studies was moderate for pain intensity (I 2 = 48%) and low for opioid consumption (I 2 = 15%). We found no evidence of a significant difference between groups in duration of post-anaesthesia care unit stay nor in Our meta-analysis differs from previous reports in its focus on immediate postoperative pain, which is directly influenced by the quality of intra-operative analgesia [36].…”

“…Our meta‐analysis differs from previous reports in its focus on immediate postoperative pain, which is directly influenced by the quality of intra‐operative analgesia [36]. However, it should be noted that the standard care varied between the included studies.…”

Energy Expenditure, a New Tool for Monitoring Surgical Stress in Colorectal Oncological Patients: A Prospective, Monocentric Study

“…Changes produced in the hemato-immunological axis generate Th1 lymphocyte cell suppression, with a consecutive Th1/Th2 lymphocyte ratio reduction, favoring the appearance of infectious complications [ 13 ]. Sympatho-adrenomedullary axis (SAM) and the hypothalamic-pituitary adrenal-axis activation can be a trigger for the occurrence of cardiac, neurological, renal, hepatic, and coagulant dysfunction, thus increasing patients’ mortality and morbidity 30 days after surgery [ 14 ]. Long-term survival is also affected, and perioperative period changes create an environment favoring metastases’ occurrence [ 15 , 16 ].…”

Intraoperative nociception and postoperative inflammation associated with the suppression of major complications due to thoracic epidural block after pleurectomy/decortication for malignant pleural mesothelioma under general anesthesia: A retrospective observational study

“…The significant decrease in mean NR in patients with TEB represents lower levels of nociception during surgery than that in patients without TEB. [5] On the other hand, the increase in the LMR indicates an increase in lymphocyte counts or a decrease in monocyte, correlating with anti-inflammation, which suppresses morbidity or mortality. [14][15][16] Previous studies have revealed that increases in sympathetic activity, accompanied by excessive nociception, contribute to hematopoiesis in the bone marrow, including neutrophils and monocytes, [17,18] This excessive acute inflammation has been shown to cause postoperative complications.…”