Nociception level-guided opioid administration in radical retropubic prostatectomy: a randomised controlled trial

Funcke, Sandra; Pinnschmidt, Hans O.; Brinkmann, Charlotte; Wesseler, Stefan; Fischer, Marlene; Nitzschke, Rainer

doi:10.1016/j.bja.2020.09.051

Cited by 29 publications

(43 citation statements)

References 26 publications

(22 reference statements)

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“…These studies showed mixed and conflicting results in both opioid consumption and perioperative adverse events. Most of these studies revealed no significant effect of nociception monitors on opioid use nor postoperative recovery (5,6,(29)(30)(31). In a recent study, Ledowski et al examined the associations between SPI, NFSC, and stress hormones in a small sample of 20 patients.…”

Section: Discussionmentioning

confidence: 99%

“…Opioids consumption in patients receiving SPI monitor was higher than that in the control group and showed a minor increase in ACTH and cortisol. However, in the PPI and NOL groups, where fewer opioids were used, more intraoperative movements occurred, and patients showed higher stress hormone levels (6). Due to these contradictory results in nociception-monitoring devices with opioid administration, stress hormone levels, and intraoperative unwanted incidents, more clinical studies should focus on the relationship between the patient's intraoperative stress hormone levels and NAN balances.…”

Section: Discussionmentioning

confidence: 99%

“…A higher opioid dose was associated with a lower serum ACTH concentration (5). In addition, although the use of PPI reduced intraoperative opioid consumption, there was a higher incidence of unwanted movement and elevated stress hormones (6). These results suggested that further optimization of these monitoring methods is warranted in the clinical setting.…”

Section: Introductionmentioning

confidence: 97%

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Developing a prediction model for estimating adrenocorticotropic hormone changes in patients undergoing scheduled open hepatectomy

Guan

Tang

et al. 2022

Ann Transl Med

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Background: Currently, there is no gold standard for monitoring patients' intraoperative stress levels under general anesthesia, while excessive stress may affect their postoperative outcomes. This prospective cohort study developed a prediction model using patients' hemodynamic parameters to predict the change in adrenocorticotropic hormone (ACTH) concentrations, one of the stress hormones, under surgical stimuli to evaluate intraoperative stress levels.Methods: A total of 205 patients undergoing scheduled open hepatectomy were enrolled in this study to investigate the correlations between ACTH levels and hemodynamic parameters. The ACTH concentration was assessed before surgery (baseline) and 10 minutes after skin incision. Blood pressure (BP) and heart rate (HR) were obtained at baseline and again at 1-minute intervals for 10 minutes after the skin incision. A logistic regression model was built to predict intraoperative stress level based on ACTH fluctuations, using the bootstrapped sampling approach. The model was validated using the internal sample.Results: Three essential variables were used in the prediction model, including two significant variables, namely, baseline ACTH and mean arterial pressure (MAP), and one variable that was close to achieving significance, that is, HR. This model was able to detect 74.9% of patients with predefined unacceptable ACTH changes. The model had an average of area under the curve (AUC) of 0.723 [95% confidence interval (CI): 0.657-0.791]. Conclusions:The model developed herein may be a potential practical method for predicting intraoperative stress levels. This prediction model may be a preliminary step to building a real-time stress model based on routine monitoring during general anesthesia, needing further validations in an external sample.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

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Developing a prediction model for estimating adrenocorticotropic hormone changes in patients undergoing scheduled open hepatectomy

Guan

Tang

et al. 2022

Ann Transl Med

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“…There are no thresholds recommended by the manufacturer for 'adequate analgesia' but in these studies, remifentanil was adjusted to maintain pupillary diameter between þ5 and þ30% of its baseline value. However, other studies performed with different methodologies, or using different pupillometric indices yielded more mitigated results [2,52].…”

Section: Pupillometry (Idmed Marseille France)mentioning

confidence: 99%

Monitoring of analgesia level during general anesthesia in children

Sabourdin

Constant

2022

Current Opinion in Anaesthesiology

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Purpose of reviewMonitoring of intraoperative nociception has made substantial progress in adult anesthesia during the last 10 years. Several monitors have been validated and their use has been associated with intraoperative or postoperative benefits in the adult population. In pediatric anesthesia, less data are available. However, several recent publications have assessed the performance of nociception monitors in children, and investigated their potential benefits in this context. This review will describe the main validated intraoperative nociception monitors, summarize adult findings and describe the available pediatric data. Recent findingsSix intraoperative nociception indices were included in this review. Among them, four have shown promising results in children: Surgical Pleth Index

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“…Clinical trials provide the evidence that forms one of the cornerstones of modern evidence-based medicine, together with clinical judgement and patient values and preferences. 1 The US National Institutes of Health defines a clinical trial as, 'a research study in which human subjects are prospectively assigned to one or more interventions (including placebo or control) to evaluate the effects of those interventions on health-related biomedical or behavioural outcomes'. 2 Clinical trials have a long history.…”

Section: Declarations Of Interestmentioning

confidence: 99%