Performance of the nasal photoplethysmographic index as an analgesic index during surgery under general anaesthesia

Park, Chanki; Yang, Minho; Choi, Bohyun; Jeon, Bokyung; Lee, Yong–Hun; Shin, Hyunki; Lee, Boreom

doi:10.1038/s41598-020-64033-0

Cited by 7 publications

(17 citation statements)

References 21 publications

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“…Because existing pain assessment methods, such as the SPI, use only certain features of a PPG that show significant changes in surgical stimuli, numerous pain-related information reflected in the PPG may be overlooked. To overcome these limitations, research has been conducted on new pain-related features derived from sophisticated PPG waveform analysis in addition to the heart rate interval and PPG amplitude reflected in the SPI [5][6][7]. However, these pain indicators still depend on complex processes, such as peak detection and feature extraction, which require accurate peak extraction algorithms and are vulnerable to signal quality degradation.…”

Section: Discussionmentioning

confidence: 99%

“…A photoplethysmogram (PPG) is a biosignal that can be obtained continuously and noninvasively using a pulse oximeter. Because a PPG conveys much information about a patient's condition, many attempts have been made to quantify pain by analyzing PPG signals [3,[5][6][7]. The surgical pleth index (SPI; GE Healthcare), developed for quantifying nociception during general anesthesia, only considers the amplitude and heartbeat interval of a PPG [3].…”

Section: Introductionmentioning

confidence: 99%

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Novel Analgesic Index for Postoperative Pain Assessment Based on a Photoplethysmographic Spectrogram and Convolutional Neural Network: Observational Study

2021

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Background Although commercially available analgesic indices based on biosignal processing have been used to quantify nociception during general anesthesia, their performance is low in conscious patients. Therefore, there is a need to develop a new analgesic index with improved performance to quantify postoperative pain in conscious patients. Objective This study aimed to develop a new analgesic index using photoplethysmogram (PPG) spectrograms and a convolutional neural network (CNN) to objectively assess pain in conscious patients. Methods PPGs were obtained from a group of surgical patients for 6 minutes both in the absence (preoperatively) and in the presence (postoperatively) of pain. Then, the PPG data of the latter 5 minutes were used for analysis. Based on the PPGs and a CNN, we developed a spectrogram–CNN index for pain assessment. The area under the curve (AUC) of the receiver-operating characteristic curve was measured to evaluate the performance of the 2 indices. Results PPGs from 100 patients were used to develop the spectrogram–CNN index. When there was pain, the mean (95% CI) spectrogram–CNN index value increased significantly—baseline: 28.5 (24.2-30.7) versus recovery area: 65.7 (60.5-68.3); P<.01. The AUC and balanced accuracy were 0.76 and 71.4%, respectively. The spectrogram–CNN index cutoff value for detecting pain was 48, with a sensitivity of 68.3% and specificity of 73.8%. Conclusions Although there were limitations to the study design, we confirmed that the spectrogram–CNN index can efficiently detect postoperative pain in conscious patients. Further studies are required to assess the spectrogram–CNN index’s feasibility and prevent overfitting to various populations, including patients under general anesthesia. Trial Registration Clinical Research Information Service KCT0002080; https://cris.nih.go.kr/cris/search/search_result_st01.jsp?seq=6638

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Novel Analgesic Index for Postoperative Pain Assessment Based on a Photoplethysmographic Spectrogram and Convolutional Neural Network: Observational Study

2021

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“…O NPI é calculado a partir da variação do ponto de pico diastólico e da variação do intervalo dos batimentos cardíacos, e mostrou ter um bom desempenho na distinção de anestesia inadequada durante a anestesia geral, apresentando desempenho semelhante com ambos os índices e menor variabilidade interindividual basal do que o SPI. 8 Dois estudos encontraram resultados que demonstraram eficácia semelhante entre ANI, SPI e pupilometria. O primeiro realizado por Vlasta Dostalova et al, é um ensaio clínico controlado randomizado com 72 pacientes adultos ASA I-III agendados para procedimentos neurocirúrgicos eletivos da coluna vertebral, observou que a monitoração de SPI e ANI forneceu orientação para o uso de sufentanil no intraoperatório e modificou significativamente o seu tempo de bolus em comparação à analgesia intra-operatória guiada por julgamento do anestesiologista.…”

Section: Discussionunclassified

“…Os estudos demonstram que o NPI é adequado para identificar anestesia inadequada na anestesia geral com propofol e remifentanil. 8 Existe, ainda, o ANI, um índice de analgesia nociceptiva desenvolvido com o objetivo de avaliar nocicepção aguda e dor. É composto por uma análise da variabilidade da frequência cardíaca e tem a frequência respiratória como fator de confusão.…”

Section: Introductionunclassified

Monitores De Nocicepção Intraoperatórios

Botelho¹,

Kroll²,

Alcoforado³

et al. 2021

Blucher Medical Proceedings

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Analisar os tipos de monitoração nociceptiva intraoperatória a fim de avaliar o melhor método.METODOLOGIA: Revisão narrativa realizada a partir de busca na base de dados PubMed utilizando os descritores "(nociception monitoring) AND (intraoperative)" aplicando o filtro "últimos 5 anos". Foram encontrados inicialmente 89 artigos dos quais, após a aplicação dos critérios de exclusão -revisões, relatos de caso, artigos que não abordavam o tema-foram selecionados 24 artigos para o presente estudo.

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“…Pupillometry is not the only analgesia monitoring device available. However, the use of analgesia monitoring devices based on RR variability or plethysmography waveform analysis may be difficult during CPB 7 , 26 , 27 . Moreover, the frequent hemodynamic changes associated with cardiac surgery can lead to changes in these parameters in addition to the effects of analgesia.…”

Section: Discussionmentioning

confidence: 99%

Pupillometry pain index decreases intraoperative sufentanyl administration in cardiac surgery: a prospective randomized study

Berthoud

Nguyen

Appriou

et al. 2020

Sci Rep

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Pupillometry has proven effective for the monitoring of intraoperative analgesia in non-cardiac surgery. We performed a prospective randomized study to evaluate the impact of an analgesia-guided pupillometry algorithm on the consumption of sufentanyl during cardiac surgery. Fifty patients were included prior to surgery. General anesthesia was standardized with propofol and target-controlled infusions of sufentanyl. The standard group consisted of sufentanyl target infusion left to the discretion of the anesthesiologist. The intervention group consisted of sufentanyl target infusion based on the pupillary pain index. The primary outcome was the total intraoperative sufentanyl dose. The total dose of sufentanyl was lower in the intervention group than in the control group and (55.8 µg [39.7–95.2] vs 83.9 µg [64.1–107.0], p = 0.04). During the postoperative course, the cumulative doses of morphine (mg) were not significantly different between groups (23 mg [15–53] vs 24 mg [17–46]; p = 0.95). We found no significant differences in chronic pain at 3 months between the 2 groups (0 (0%) vs 2 (9.5%) p = 0.49). Overall, the algorithm based on the pupillometry pain index decreased the dose of sufentanyl infused during cardiac surgery.Clinical trial number: NCT03864016.

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Performance of the nasal photoplethysmographic index as an analgesic index during surgery under general anaesthesia

Cited by 7 publications

References 21 publications

Novel Analgesic Index for Postoperative Pain Assessment Based on a Photoplethysmographic Spectrogram and Convolutional Neural Network: Observational Study

Novel Analgesic Index for Postoperative Pain Assessment Based on a Photoplethysmographic Spectrogram and Convolutional Neural Network: Observational Study

Monitores De Nocicepção Intraoperatórios

Pupillometry pain index decreases intraoperative sufentanyl administration in cardiac surgery: a prospective randomized study

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