Monitoring of the responsiveness to noxious stimuli during anaesthesia with propofol and remifentanil by using RIII reflex threshold and bispectral index

Abstract

RIII threshold and BIS are both influenced dose-dependently by remifentanil at those concentrations that suppress reactions to noxious stimuli. The susceptibility of the parameters to remifentanil concentration seems to be of a similar quality. Under different ratios of propofol and remifentanil concentrations, the RIII threshold correlates with non-responsiveness better than the BIS.

Utility of Nociceptive Flexion Reflex Threshold, Bispectral Index, Composite Variability Index and Noxious Stimulation Response Index as measures for nociception during general anaesthesia

“…This yields an apparent association between higher doses of propofol and more movement responses. The inability of BIS and CVI to predict responses in this study despite their rather good performance in other studies [2][3][4][5] can be explained by the study design. As we did not strictly control anaesthetic doses through the study protocol, we assessed the devices in a situation that mirrors normal clinical practice with normal dosing variability and predictor variability.…”

“…Effect-compartment concentrations and NSRI also predict movement (but not heart rate) responses satisfactorily.Although the cerebral effect of hypnotics may be monitored using processed electroencephalography, no comparable monitor exists to measure nociception during general anaesthesia. In clinical practice, opioids are administered according to haemodynamic and movement responses to noxious stimuli [1].The correlation of such responses with the hypnotic depth as measured by the bispectral index (BIS) is relatively poor [2,3]. The composite variability index (CVI), which is derived from the BIS, may provide a better correlation and whereas promising results are presented in abstract form [4,5], no full research paper has yet been published.The nociceptive flexion reflex (NFR) is a polysynaptic spinal withdrawal reflex, which can be assessed by electromyography of the biceps femoris muscle…”

Recent advance in patient monitoring

“…The RIII reflex threshold correlates with non-responsiveness better than the BIS in propofol-remifentanil anesthesia [41]. To assess the RIII reflex, biceps femoris muscle activity is monitored using an electromyogram during the application of electrocutaneous stimuli to the ipsilateral sural nerve.…”

Higher doses of intraoperative analgesia are associated with lower levels of persistent pain and less analgesic consumption six months after total hip arthroplasty

“…Currently, a variety of different tools to measure intraoperative nociception and/or analgesia are under investigation in clinical studies. These are based on a wide range of physiological mechanisms including skin conductance (Storm, ), haemodynamics (Wennervirta et al., ; Rossi et al., ; Gruenewald et al., , ), electroencephalogram (Haenggi et al., ; Sahinovic et al., ) and a variety of nociceptive reflexes (von Dincklage et al., , , ; Paulus et al., ; Guglielminotti et al., ; Ly‐Liu and Reinoso‐Barbero, ; Jakuscheit et al., ). Currently, however, none of the tools have been shown to have enough specificity/sensitivity to outweigh the effort and cost of their routine clinical application (Gruenewald and Ilies, ; von Dincklage, ).…”