Validation of Innovative Techniques for Monitoring Nociception during General Anesthesia

Funcke, Sandra; Sauerlaender, Sven; Pinnschmidt, Hans O.; Saugel, Bernd; Bremer, Kai; Reuter, Daniel A.; Nitzschke, Rainer

doi:10.1097/aln.0000000000001670

Cited by 79 publications

(78 citation statements)

References 28 publications

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“…Similar results have been reported previously. 15 Despite its limitations, it may be the poor performance of the 'traditional' parameters such as MAP and HR which create an ongoing significant interest in SPI and similar tools to monitor nociception. Though closed-loop anaesthesia systems using either bispectral index alone or combining it with MAP or HR-based analgesia scores have been found feasible, 16e18 the analgesia component of such systems may require further research.…”

Section: Discussionmentioning

confidence: 99%

Surgical pleth index: prospective validation of the score to predict moderate-to-severe postoperative pain

Ledowski

Schneider

Gruenewald

et al. 2019

British Journal of Anaesthesia

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Background: Reported outcome benefits after surgical pleth index (SPI, GE Healthcare, Helsinki, Finland) guided anaesthesia are conflicting. One potential explanation may be the lack of evidence for the selection of meaningful SPI target values. A recently published trial found an SPI cut-off of 30 as a 'best-fit' to predict moderate-to-severe acute postoperative pain. This prospective trial was designed to validate this target and to investigate the influence of patient age on SPI in this context. Methods: After ethics approval, 200 patients undergoing non-emergency surgery were enrolled. Data related to SPI, heart rate (HR), and mean arterial pressure (MAP) were recorded for the last 5 min of surgery, just before arousal. After admission to recovery, pain scores (numeric rating scale [NRS], 0e10) were obtained every 5 min for 15 min. Results: The data of 196 patients were analysed. Receiver-operating curve analysis showed a cut-off SPI value of 29 to be the optimum intraoperative target to discriminate between NRS 0e3 and 4e10. This confirms the 'best fit' cut-off for SPI published previously. Though still superior to HR and MAP, the sensitivity and specificity of the SPI were only poor. Age had no influence on the predictive accuracy of SPI. Conclusions: An SPI of approximately 30 was confirmed as having the best sensitivity/specificity to predict moderate-tosevere pain in the postanaesthesia care unit. However, the predictive accuracy was overall poor and not influenced by patient age. Clinical trial registration: ACTRN12617001475336.

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Section: Discussionmentioning

confidence: 99%

Surgical pleth index: prospective validation of the score to predict moderate-to-severe postoperative pain

Ledowski

Schneider

Gruenewald

et al. 2019

British Journal of Anaesthesia

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“…In this study, we defined hemodynamic reactivity as an increase of more than 20% of either MBP or HR after 1 minute of painful stimulus. In adult patients, hemodynamic reactivity was often defined as an increase by more than 20% of HR and/or blood pressure within 5 min or following 2 min after noxious stimulation [6,21,25]. Through preliminary experiment, we found that in pediatric patients the hemodynamic response caused by nociception changes fast; Hemodynamic changes may have returned to normal five minutes after intubation or skin incision.…”

Section: Discussionmentioning

confidence: 93%

“…Researches have shown that these tools might reflect the nociception during general anesthesia [1,16,21]. However, these parameters are mainly aimed at adult patients and affected by arrhythmia alongside many heart rate affecting drugs [6,25]. Pain Rating Index (PRI) is a cerebral pain tolerance indicator based on EEG signals.…”

Section: Discussionmentioning

confidence: 99%

“…Nociception in anesthetized patients is typically demonstrated as sympathetic response to surgery and other noxious stimuli [4,5]. Excessive nociception not only affects the stability of hemodynamics, but may also exacerbate postoperative pain, disturb the balance of inflammation, and cause adverse outcomes [6,7]. Analgesic administration is the key component of enhancing anti-nociceptive forces, which is mainly determined by the anesthesiologist's clinical experience [8].…”

Section: Introductionmentioning

confidence: 99%

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Prediction of hemodynamic reactivity by electroencephalographically derived Pain Rating Index in children during general anesthesia: a prospective observational study

Wang²,

Wang

et al. 2019

Preprint

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Background: Pain rating index (PRI) is a novel measure of nociception based on integrated electroencephalogram parameters during general anesthesia. Wavelet index (WLI) as a sedation index reflects the patient's sedation state. This study aims to evaluate the performance of PRI and WLI to predict hemodynamic reactivity after tracheal intubation and skin incision in pediatric patients. Methods: 134 children undergoing elective general or urinary surgery were analyzed. PRI, WLI, heart rate (HR), and mean blood pressure (MBP) were measured at predefined time-points during tracheal intubation and skin incision. Receiver-operating characteristic (ROC) curves were computed to evaluate the predictive performance of PRI and WLI to measure hemodynamic reactivity (increase by more than 20% of either MBP or HR) during general anesthesia. Results: In 134 patients, positive reactivity of HR and MBP was observed in 95 (70.9%) and 61 (45.5%) patients induced by endotracheal intubation and 19 (14.2%) and 24 (17.9%) patients induced by skin incision. Using either HR or MBP reactivity induced by tracheal intubation as a dichotomous variable, the areas under the curves (AUCs) [95% CI] of PRI and WLI were 0.81[0.73-0.87] and 0.58[0.49-0.67] with the best cutoff values of 62 and 49; The AUCs [95% CI] of PRI and WLI were 0.82[0.75-0.88] and 0.61[0.52-0.69] after skin incision, the best cutoff values of PRI and WLI were 60 and 46, respectively. Conclusions: PRI can predict hemodynamic reactivity with the best cutoff values of 62 and 60 after tracheal intubation and skin incision in pediatric patients during general anesthesia while WLI failed in predicting hemodynamic changes. Trial registration: Chinese Clinical Trial Register (Unique identifier: ChiCTR1800015969, Date of registration: May 3, 2018). Key words: Pain Rating Index, Wavelet index, Hemodynamic reactivity, Pediatric patients

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“…For example, the surgical plethysmographic index (SPI) and analgesia nociception index (ANI), which use autonomic responses to measure noxious stimulation. [1][2][3][4] Response Entropy TM (RE) and…”

Section: Introductionmentioning

confidence: 99%

Differentiation of skin incision and laparoscopic trocar insertion via quantifying transient bradycardia measured by electrocardiogram

Chang

Fang²,

Wang³

et al. 2019

J Clin Monit Comput

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Background. Most surgical procedures involve structures deeper than the skin. However, the difference in surgical noxious stimulation between skin incision and laparoscopic trocar insertion is unknown. By analyzing instantaneous heart rate (IHR) calculated from the electrocardiogram, in particular the transient bradycardia in response to surgical stimuli, this study investigates surgical noxious stimuli arising from skin incision and laparoscopic trocar insertion.Methods. Thirty-five patients undergoing laparoscopic cholecystectomy were enrolled in this prospective observational study. Sequential surgical steps including umbilical skin incision (11 mm), umbilical trocar insertion (11 mm), xiphoid skin incision (5 mm), xiphoid trocar insertion (5 mm), subcostal skin incision (3 mm), and subcostal trocar insertion (3 mm) were investigated. IHR was derived from electrocardiography and calculated by the modern time-varying power spectrum. Similar to the classical heart rate variability analysis, the time-varying low frequency power (tvLF), time-varying high frequency power (tvHF), and tvLF-to-tvHF ratio (tvLHR) were calculated. Prediction probability (P K ) analysis and global pointwise F-test were used to compare the performance between indices and the heart rate readings from the patient monitor.Results. Analysis of IHR showed that surgical stimulus elicits a transient bradycardia, followed by the increase of heart rate. Transient bradycardia is more significant in trocar insertion than skin incision. The IHR change quantifies differential responses to different surgical intensity. Serial P K analysis demonstrates de-sensitization in skin incision, but not in laparoscopic trocar insertion. Conclusions. Quantitative indices present the transient bradycardia introducedby noxious stimulation. The results indicate different effects between skin incision and trocar insertion.

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Validation of Innovative Techniques for Monitoring Nociception during General Anesthesia

Cited by 79 publications

References 28 publications

Surgical pleth index: prospective validation of the score to predict moderate-to-severe postoperative pain

Surgical pleth index: prospective validation of the score to predict moderate-to-severe postoperative pain

Prediction of hemodynamic reactivity by electroencephalographically derived Pain Rating Index in children during general anesthesia: a prospective observational study

Differentiation of skin incision and laparoscopic trocar insertion via quantifying transient bradycardia measured by electrocardiogram

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