Quantitative assessment of a pediatric nociception monitor in children under sevoflurane anesthesia

Abstract

IntroductionIntraoperative monitoring of nociception has recently made substantial progress in adult anesthesia. In contrast, pediatric data are scarce. Newborn-Infant Parasympathetic Evaluation (NIPE index, Mdoloris Medical Systems, Loos, France) is the first nociception index specifically designed for young children. It is a dimensionless index comprised between 0 and 100. Two previous studies suggested that NIPE could indeed ‘detect’ nociception in anesthetized children. The objective of our study was to investigate if NIPE allowed to detect and to provide a quantitative assessment of nociception in children.MethodsChildren were anesthetized with sevoflurane, and received a bolus of alfentanil (10 µg/kg before intubation). Before surgical incision, each participant received three tetanic stimulations (5 s, 100 Hertz) with a 5 min interval, in a randomized order: 10, 30 and 60 milliamps. NIPE and heart rate variations were assessed after each stimulation.ResultsThirty children (2.4±1.6 years) were included. Mean delay between alfentanil and the first stimulation was 19±4 min. Mean baseline NIPE was 75±10. NIPE variation after the stimulations was significant at 10, 30 and 60 mA (linear mixed regression model, p<0.001). The intensity of stimulation significantly influenced the amplitude of NIPE variation (linear mixed regression model p<0.001), but had no statistically significant effect on heart rate variation (p=0.52).DiscussionNIPE might allow a quantitative assessment of nociception in young children in these anesthetic conditions. This study provides a basis for future research investigating the potential benefits of NIPE-guided intraoperative analgesia in pediatric anesthesia.Trial registration numberNCT04381637.

Evaluation of Nociception during Pediatric Surgery: A Topical Review

“…The ANI Monitor displays two averaged ANI measurements: the ANIi results from the average of ANI measured over the previous 120 s, and the ANIm results from the average of ANI measured over the previous 240 s. The ANI algorithm is set for a heart rate range of 30–180 beats/min, whereas the NIPE algorithm range is between 80 and 250 beats/min. The ANI has shown a good performance in predicting intraoperative nociceptive stimuli in animals [ 41 ], adults [ 31 , 41 ] and older children [ 8 , 42 , 43 , 44 , 45 ]. In adults, ANI showed 88% sensitivity and 83% specificity in predicting hemodynamic changes [ 22 ].…”

Looking backward to move forward in perioperative pain management?

“…Compared with the Analgesia-Nociception Index (ANI) which has been validated in adults, the NIPE algorithm remains unvalidated. As described by the authors, ‘NIPE is expected to decrease after a nociceptive stimulation’ 1. Under the standardized protocol of approximately 1 minimum alveolar concentration of sevoflurane anesthesia and prior to the start of surgery, 30 children aged 6 months to 6 years were exposed to a series of three 5 s 100 Hz tetanic stimulations of varying intensity (10, 30, and 60 mA) applied to the distal upper extremity over the ulnar nerve in random order and separated by 6 min.…”

“…In RAPM , Lebrun et al present the results of a prospective study evaluating the use of the newborn infant parasympathetic evaluation (NIPE) to quantify nociception in anesthetized children prior to surgery 1. NIPE monitoring is non-invasive and gathers data from the ECG to assess heart rate variability as an estimate of nociception 2.…”