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Park JB, Kang P, Ji SH, Jang YE, Lee JH, Kim JT, Kim HS, Kim EH. Effects of goal-directed analgesia using the analgesia nociception index in children undergoing surgery for moyamoya disease: A randomised controlled trial. Eur J Anaesthesiol 2024; 41:649-656. [PMID: 38832435 DOI: 10.1097/eja.0000000000002013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
BACKGROUND The potential benefits of Analgesia Nociception Index guided intra-operative analgesia on intra-operative opioid consumption remains to be demonstrated in paediatric anaesthesia. OBJECTIVES This study aimed to explore the effects of Analgesia Nociception Index guided analgesia on sufentanil consumption during anaesthesia and postoperative pain scores in paediatric patients with moyamoya disease. DESIGN A prospective randomised controlled study. SETTING Seoul National University Children's Hospital, Seoul, Republic of Korea. PATIENTS A total of 40 children scheduled for encephaloduroarteriosynangiosis. MAIN OUTCOME MEASURES The primary outcome was total intra-operative sufentanil consumption, and the secondary outcomes included postoperative pain scores and incidence of opioid-related adverse events. RESULTS The Analgesia Nociception Index group showed lower intra-operative sufentanil consumption (in μg kg -1 h -1 ) compared with the Standard group (0.30 ± 0.12 and 0.39 ± 0.17, respectively; mean difference, -0.09; 95% confidence interval, -0.19 to 0.00; P = 0.049). Postoperatively, compared with the Standard group, the Analgesia Nociception Index group reported lower median pain scores at 18 and 24 h and maximum pain within 24 h (1 [0 to 2] vs. 3 [2 to 5]; P = 0.004, 1 [0 to 2] vs. 3 [1 to 4]; P = 0.041, and 4 [3 to 5] vs. 5 [4 to 7]; P = 0.045, respectively), with fewer patients experiencing nausea (3 [15%] vs. 10 [50%], P = 0.043). CONCLUSION The Analgesia Nociception Index guided analgesic protocol can reduce intra-operative sufentanil consumption and postoperative pain within 24 h with fewer nausea symptoms in paediatric patients with moyamoya disease who undergo encephaloduroarteriosynangiosis. TRIAL REGISTRATION NUMBER NCT05672212.
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Affiliation(s)
- Jung-Bin Park
- From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea (J-BP, PK, S-HJ, Y-EJ, J-HL, J-TK, H-SK, E-HK)
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Bonvecchio E, Vailati D, Mura FD, Marino G. Nociception level index variations in ICU: curarized vs non-curarized patients - a pilot study. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2024; 4:57. [PMID: 39164731 PMCID: PMC11337812 DOI: 10.1186/s44158-024-00193-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 08/09/2024] [Indexed: 08/22/2024]
Abstract
PURPOSE Pain is a major physiological stressor that can worsen critical medical conditions in many ways. Currently, there is no reliable monitoring tool which is available for pain monitoring in the deeply sedated ± curarized critically ill patients. This study aims to assess the effectiveness of the multiparameter nociception index (NOL®) in the critical care setting. We compared NOL with traditionally used neurovegetative signs and examined its correlation with sedation depth measured by bispectral index (BIS®) electroencephalographic (EEG) monitoring. METHODS This retrospective monocentric cohort study was conducted in a general intensive care unit, including patients who required moderate-to-deep levels of sedation with or without continuous neuromuscular blockade. The performance of NOL was evaluated both in the entire studied population, as well as in two subgroups: curarized and non-curarized patients. RESULTS NOL demonstrated greater accuracy than all other indicators in pain detection in the overall population. In the non-curare subgroup, all indices correctly recognized painful stimulation, while in the patients subjected to neuromuscular blocking agent's infusion, only NOL properly identified nociception. In the former group, EEG's relation to nociception was on the border of statistical significance, whereas in the latter BIS showed no correlation with NOL. CONCLUSION NOL emerges as a promising device for pain assessment in the critical care setting and exhibits its best performance precisely in the clinical context where reliable pain assessment methods are most lacking. Furthermore, our research confirms the distinction between sedation and analgesia, highlighting the necessity for distinct monitoring instruments to accurately assess them.
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Affiliation(s)
- Emilio Bonvecchio
- ICU and Anaesthesia Department, Melegnano Hospital-ASST Melegnano and Martesana, Vizzolo Predabissi, Milan, Italy.
| | - Davide Vailati
- ICU and Anaesthesia Department, Melegnano Hospital-ASST Melegnano and Martesana, Vizzolo Predabissi, Milan, Italy
| | - Federica Della Mura
- ICU and Anaesthesia Department, Melegnano Hospital-ASST Melegnano and Martesana, Vizzolo Predabissi, Milan, Italy
| | - Giovanni Marino
- ICU and Anaesthesia Department, Melegnano Hospital-ASST Melegnano and Martesana, Vizzolo Predabissi, Milan, Italy
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Sogut MS, Kalyoncu I, Karakaya MA, Manici M, Darçin K. Does Nociception Level Index-Guided Opioid Administration Reduce Intraoperative Opioid Consumption? A Systematic Review and Meta-Analysis. Anesth Analg 2024:00000539-990000000-00889. [PMID: 39093819 DOI: 10.1213/ane.0000000000007180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
BACKGROUND The nociception level (NOL) index is a quantitative parameter derived from physiological signals to measure intraoperative nociception. The aim of this systematic review and meta-analysis was to evaluate if NOL monitoring reduces intraoperative opioid use compared to conventional therapy (opioid administered at clinician discretion). METHODS This meta-analysis comprises randomized clinical trials comparing NOL-guided opioid administration to conventional therapy in adult patients undergoing any type of surgery. A systematic search of PubMed, Scopus, and CENTRAL databases was conducted. The primary outcome was intraoperative opioid consumption and the effect estimate of the NOL index was measured using the standardized mean difference (SMD) where 0.20 is considered a small and 0.80 a large effect size. A random-effects model with Hartung-Knapp-Sidik-Jonkman adjustment was applied to estimate the treatment effect. Heterogeneity was explored clinically and statistically (using the inconsistency I² statistic, prediction intervals, and influence analysis). The quality (certainty) of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) guidelines methodology. RESULTS This review comprised 9 trials (519 patients). The intraoperative opioid SMD (NOL monitoring versus conventional therapy) was -0.26 (95% confidence interval [CI], -0.82 to 0.30; P = .31; low certainty of evidence). We observed substantial clinical (intraoperative opioid regimens) and statistical heterogeneity with the I² statistic being 86% (95% CI, 75%-92%). The prediction interval was between -1.95 and 1.42 indicating where the SMD between NOL and conventional therapy would lie if a similar study were conducted in the future. CONCLUSIONS This meta-analysis does not provide evidence supporting the role of NOL monitoring in reducing intraoperative opioid consumption.
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Affiliation(s)
- Muhammet Selman Sogut
- From the Department of Anesthesiology and Reanimation, Koç University School of Medicine, Istanbul, Turkey
| | - Ilayda Kalyoncu
- From the Department of Anesthesiology and Reanimation, Koç University School of Medicine, Istanbul, Turkey
| | - Muhammet Ahmet Karakaya
- Department of Anesthesiology and Reanimation, Acibadem University School of Medicine, Istanbul, Turkey
| | - Mete Manici
- From the Department of Anesthesiology and Reanimation, Koç University School of Medicine, Istanbul, Turkey
| | - Kamil Darçin
- From the Department of Anesthesiology and Reanimation, Koç University School of Medicine, Istanbul, Turkey
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Laskou S, Tsaousi G, Pourzitaki C, Papazisis G, Kesisoglou I, Sapalidis K. Efficacy and Safety of Magnesium Sulfate as an Adjunct to Ropivacaine Wound Infiltration in Thyroid Surgery: A Prospective, Double-Blind, Randomized Controlled Trial. J Clin Med 2024; 13:4499. [PMID: 39124765 PMCID: PMC11313512 DOI: 10.3390/jcm13154499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 07/18/2024] [Accepted: 07/27/2024] [Indexed: 08/12/2024] Open
Abstract
Background/Objective: Wound infiltration with local anesthetics emerges as a promising modality for postoperative pain alleviation. However, such strategies in neck surgery have not been a well-established practice. To assess wound infiltration with ropivacaine plus magnesium sulfate for pain relief following thyroid surgery. Methods: This prospective, double-blind, randomized study enrolled 68 patients who underwent thyroid surgery. Concerning the solution used for surgical wound infiltration, the study participants were randomly allocated into three groups: (1) 100 mg of ropivacaine (Group R); (2) 100 mg of ropivacaine plus magnesium sulfate 10 mg/kg (Group RMg); and (3) normal saline which served as a placebo (Group P). Pain perception both at rest and at movement, was measured using the Visual Analogue Scale (VAS) at 30 min, as well as at 1, 2, 4, 6, 12, and 24 h postoperatively. The total consumption of analgesics in morphine equivalents was also recorded. Moreover, adverse effects and patient satisfaction were recorded. Cortisol, TNF-α, and IL-6 levels were measured 30 min before infiltration and 6 h and 24 h postoperatively. Results: Demographics and clinical characteristics were similar between the groups. The VAS scores at rest and during movement were significantly lower in the RMg group compared to the saline or ropivacaine groups. Total analgesic consumption was also significantly lower in the RMg group. No operation-, wound-, or infiltration-related adverse effects were recorded in the study groups. Better overall satisfaction was obtained for the RMg group. Conclusions: Ropivacaine plus magnesium sulfate wound infiltration provided better pain control and the analgesic effect was more significant, contributing to effective postoperative analgesia in patients undergoing thyroid surgery.
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Affiliation(s)
- Stiliani Laskou
- 3rd Surgical Department, School of Medicine, Aristotle University of Thessaloniki, 1st St. Kiriakidi Str, 54636 Thessaloniki, Greece; (I.K.); (K.S.)
| | - Georgia Tsaousi
- Clinic of Anesthesiology and Intensive Care, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Chryssa Pourzitaki
- Department of Clinical Pharmacology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54006 Thessaloniki, Greece; (C.P.); (G.P.)
| | - Georgios Papazisis
- Department of Clinical Pharmacology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54006 Thessaloniki, Greece; (C.P.); (G.P.)
| | - Isaak Kesisoglou
- 3rd Surgical Department, School of Medicine, Aristotle University of Thessaloniki, 1st St. Kiriakidi Str, 54636 Thessaloniki, Greece; (I.K.); (K.S.)
| | - Konstantinos Sapalidis
- 3rd Surgical Department, School of Medicine, Aristotle University of Thessaloniki, 1st St. Kiriakidi Str, 54636 Thessaloniki, Greece; (I.K.); (K.S.)
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Gavet M, Cardinali M, Bernady A, Ruiz CC, Allaouchiche B, Junot S. Evaluation of the Surgical Pleth Index (SPI) for the monitoring of the nociception-antinociception balance in dogs undergoing castration: A prospective clinical trial. Res Vet Sci 2024; 175:105320. [PMID: 38838512 DOI: 10.1016/j.rvsc.2024.105320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 05/29/2024] [Accepted: 05/30/2024] [Indexed: 06/07/2024]
Abstract
The aim of this prospective clinical study was to evaluate the efficacy of the Surgical Pleth Index (SPI), a validated nociception monitor in human anaesthesia, in dogs. The technology uses a plethysmographic signal from a specific pulse oximetry probe to analyse pulse wave amplitudes and heartbeat intervals. Twenty-six healthy dogs anaesthetised for castration were included. SPI, invasive mean arterial pressure (MAP) and heart rate (HR) were continuously monitored. The occurrence or resolution of a haemodynamic reaction (HDR), defined as a > 20% increase in HR and/or MAP, was assessed at predefined times: cutaneous incision, testicles' exteriorization, cutaneous suture, and fentanyl administration. Following nociceptive events, the dogs presenting a HDR showed a significant 8% and 10% increase in SPI at 3 and 5 min respectively, whereas after fentanyl administration, a 13% and 16% significant decrease in SPI were noted. Receiver operating characteristic curves analysis indicated a moderate performance for the dynamic variations of SPI over 1 min to predict a HDR (AUC: 0.68, threshold value: +15%) or its resolution after fentanyl administration (AUC of 0.72, threshold value: -15%) within 3 min. The SPI varied according to perioperative nociceptive events and analgesic treatment; however, its performance to anticipate a HDR was limited with high specificity but low sensivity. Refinement of the algorithm to specifically accommodate for the canine species may be warranted. Further studies are required to evaluate the influence of other factors on the performance of this index.
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Affiliation(s)
- Morgane Gavet
- Université de Lyon, Service d'anesthésie, VetAgro Sup, 1 avenue Bourgelat F-69280 Marcy l'Etoile, France.
| | - Martina Cardinali
- Université de Lyon, Service d'anesthésie, VetAgro Sup, 1 avenue Bourgelat F-69280 Marcy l'Etoile, France
| | - Angelique Bernady
- Université de Lyon, Service d'anesthésie, VetAgro Sup, 1 avenue Bourgelat F-69280 Marcy l'Etoile, France
| | - Clara Conde Ruiz
- Université de Lyon, Service d'anesthésie, VetAgro Sup, 1 avenue Bourgelat F-69280 Marcy l'Etoile, France.
| | - Bernard Allaouchiche
- Université de Lyon, APCSe Agressions Pulmonaires et Circulatoires dans le Sepsis, VetAgro Sup, 1 avenue Bourgelat F-69280 Marcy l'Etoile, France; Université de Lyon, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Réanimation Medicale, 165 Chemin du Grand Revoyet, F-69310 Pierre-Bénite, France
| | - Stephane Junot
- Université de Lyon, Service d'anesthésie, VetAgro Sup, 1 avenue Bourgelat F-69280 Marcy l'Etoile, France; Université de Lyon, APCSe Agressions Pulmonaires et Circulatoires dans le Sepsis, VetAgro Sup, 1 avenue Bourgelat F-69280 Marcy l'Etoile, France.
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Mascaró Triedo CE, Karar S, Abunemeh M, Portier K. Effect of nose twitching on the pupillary dilation in awake and anesthetized horses. Front Vet Sci 2024; 11:1412755. [PMID: 39036796 PMCID: PMC11258756 DOI: 10.3389/fvets.2024.1412755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 06/26/2024] [Indexed: 07/23/2024] Open
Abstract
Pupillometry is used in humans to monitor pain, nociception and analgesia. This single-center, non-randomized, non-blinded intervention trial, evaluated the effect of nose twitching on the pupil size in awake, sedated, and anesthetized horses. Pupil height (H) and length (L) were measured before (Be) and after (Af) nose twitching in fourteen non-painful adult awake horses (T0). The percentage of variation (PSV) was calculated (PSVTn = [(TnAf-TnBe)/TnBe]*100). Measurements were repeated (Tn) after acepromazine (0.04 mg kg-1 IV) (T1), romifidine (0.04 mg kg-1 IV) (T2), morphine (0.1 mg kg-1 IV) (T3), after anesthesia induction with diazepam (0.05 mg kg-1 IV) and ketamine (2.2 mg kg-1 IV), at the time the horse was placed on the operating table (T4) and when the expiratory fraction of sevoflurane was 2% (T5). HAf vs. HBe, LAf vs. LBe as well as PSVH vs. PSVL at each time were compared with a Mann-Whitney Wilcoxon test. The PSVL and PSVH, as well as HBe and LBe over time were compared with the Skillings-Mack test followed by a Wilcoxon test for paired data to make pairwise comparisons (Tn + 1 vs. Tn). In non-sedated horses (T0), the application of the nose twitch induced a significant increase in pupil length (LT0Be: 17.09 [16.05; 19.67] mm versus LT0Af: 19.52 [18.74; 21.40]) mm (p = 0.004). Thirty minutes after acepromazine administration (T1), nose twitching induced a significant increase in pupil length (LT1Be: 16.45 [14.80; 18.66] mm versus LT1Af 18.31 [17.20; 20.52] mm) (p = 0.016) and height (HT1Be: 8.44 [5.68; 12.04] mm versus HT1Af: 11.09 [7.97; 14.3] mm) (p < 0.001). PSVHT1 was significantly greater than PSVLT1 (p = 0.025). PSVH was higher at T1 than at T0 (p = 0.04). It was also significantly higher at T1 than at T2 (p < 0.001). Romifidine induced mydriasis (HT2Be 16.95 [14.73; 18.77] mm versus HT1Be 8.44 [5.68; 12.04] mm) (p < 0,001) (LT2Be 19.66 [18.45; 20.41] mm versus LT1Be 16.45 [14.80; 18.66] mm) (p < 0.001). The results suggest that nose twitching induced a pupillary dilation in the awake horse. This effect was potentiated after the administration of acepromazine but disappeared after the administration of romifidine.
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Affiliation(s)
| | - Sahra Karar
- VetAgro Sup, CREFAC, Université de Lyon, Marcy l’Etoile, France
| | - Maha Abunemeh
- VetAgro Sup, CREFAC, Université de Lyon, Marcy l’Etoile, France
| | - Karine Portier
- VetAgro Sup, CREFAC, Université de Lyon, Marcy l’Etoile, France
- Centre de Recherche en Neurosciences de Lyon, INSERM, CRNL U1028 UMR5292, Trajectoire, Université Claude Bernard Lyon 1, Bron, France
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Basson EP, Kadwa AR, Blignaut CJ, Zeiler GE. Physiological variables for the objective detection of nerve block failure in dogs. Vet Anaesth Analg 2024; 51:343-353. [PMID: 38772854 DOI: 10.1016/j.vaa.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 02/29/2024] [Accepted: 03/25/2024] [Indexed: 05/23/2024]
Abstract
OBJECTIVE To identify physiological variables for objectively detecting nociception indicative of intraoperative peripheral nerve block failure. STUDY DESIGN A double-blinded randomized clinical study. ANIMALS A sample of 14 male (40.8 ± 12 kg; mean ± standard deviation) and 16 female (34.3 ± 11.4 kg) client-owned dogs. METHODS Dogs were randomly assigned to one of three groups for psoas compartment and proximal sciatic nerve blocks (0.2 mL kg-1 per site): guided bupivacaine (GBB), or saline (GSB) block or a blind bupivacaine block (BBB). Guided blocks were performed using an ultrasound-peripheral nerve locator combination. Premedication consisted of medetomidine 0.01 mg kg-1 and morphine 0.3 mg kg-1. General anaesthesia was induced with propofol and maintained with isoflurane in oxygen. Receiver operator characteristic curve analysis was used to compare actual values and change in values of physiological variables between GSB and GBB. The Youden index and associated criterion for each physiological variable were used to determine an objective measure for nociception. Fisher's exact t test, McNemar's test and Cohen's kappa statistical analysis were used to determine association, differences and inter-score reliability between the objective and subjective scoring for BBB. RESULTS Cardiovascular variables had good discriminating ability to identify a nociceptive response (p < 0.01). The Youden indices for mean (MAP) and diastolic (DAP) arterial pressure were most reliable in detecting nociception. The highest sensitivity was that of ΔMAP (100%) with good agreement between the subjective and objective scores of Δheart rate or systolic arterial pressure (SAP). The use of ΔMAP, ΔSAP, ΔDAP had the best ability in indicating peripheral nerve block failure (p < 0.001). CONCLUSIONS AND CLINICAL RELEVANCE Blood pressure values can detect a response to surgical stimulus in adequately anaesthetized dogs. The use of ΔMAP, ΔSAP or ΔDAP may be considered as objective measures to detect nerve block failure.
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Affiliation(s)
- Etienne P Basson
- Anaesthesia and Critical Care Services, Valley Farm Animal Hospital, Pretoria, South Africa; Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa.
| | - Abdur R Kadwa
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
| | - Christiaan J Blignaut
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
| | - Gareth E Zeiler
- Anaesthesia and Critical Care Services, Valley Farm Animal Hospital, Pretoria, South Africa; Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
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Jeanne M. When nociception monitoring becomes predictive of surgical outcomes : has the future already become real ? J Clin Monit Comput 2024; 38:561-563. [PMID: 38438705 PMCID: PMC11164713 DOI: 10.1007/s10877-024-01139-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 02/08/2024] [Indexed: 03/06/2024]
Affiliation(s)
- Mathieu Jeanne
- Inserm, CIC 1403, Lille, F-59000, France.
- Univ. Lille, EA 7365 - GRITA, Lille, F-59000, France.
- CHU Lille, Anesthesia and critical care, Lille, F-59000, France.
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Wang H, Wang Q, He Q, Li S, Zhao Y, Zuo Y. Current perioperative nociception monitoring and potential directions. Asian J Surg 2024; 47:2558-2565. [PMID: 38548545 DOI: 10.1016/j.asjsur.2024.03.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 06/05/2024] Open
Abstract
Perioperative nociception-antinociception balance is essential for the prevention of adverse postoperative events. Estimating the nociception level helps optimize intraoperative management. In the past two decades, various nociception monitoring devices have been developed for the identification of intraoperative nociception. However, each type of nociception monitoring device has advantages and disadvantages, limiting their clinical application in particular patients and settings. Therefore, this review aimed to summarize the information on nociceptor monitoring in current clinical settings, explore each technique's particularities, and possible future directions to provide a reference for clinicians and researchers.
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Affiliation(s)
- Haiyan Wang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, China
| | - Qifeng Wang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, China
| | - Qinqin He
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, China
| | - Shikuo Li
- Department of Anesthesiology, Yan'an Hospital of Kunming City, Kunming Medical University, Kunming, Yunnan, China
| | - Yuyi Zhao
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yunxia Zuo
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, China.
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Miyamoto K, Saeki A, Oshita S, Kobata M, Takami R, Miyamoto D, Okutani H, Ueki R, Kariya N, Hirose M. Age-related changes in intraoperative mean values of nociceptive response in patients undergoing non-cardiac surgery under general anesthesia: A retrospective cohort study. J Clin Monit Comput 2024; 38:581-589. [PMID: 38280112 DOI: 10.1007/s10877-023-01125-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/29/2023] [Indexed: 01/29/2024]
Abstract
Intraoperative nociception is affected by preoperative factors, surgical invasiveness, and anesthesia. Although age-related changes in nociception in conscious humans have been well examined, those in intraoperative nociception in unconscious patients under general anesthesia are unknown. To clarify associations between age and intraoperative nociception under general anesthesia, we performed a retrospective cohort study in consecutive patients of all ages undergoing non-cardiac surgery under general anesthesia from January 2019 to July 2023. The intraoperative nociception value in each surgery was assessed by the averaged value of nociceptive response (mean NR) index during surgery. Patient characteristics, including age, sex, body mass index (BMI), emergent surgery, preoperative serum C-reactive protein (CRP) level, and comorbidities were also collected. After excluding patients with missing data of CRP and mean NR index, 22,061 patients were enrolled, and were divided into low, intermediate, and high surgical risk groups. Multivariable regression analysis showed a significant association between age and mean NR index in all three surgical procedure risk groups. The preoperative variables of CRP levels, BMI, emergent surgery, atrial fibrillation, renal failure, and long-term steroid use also showed significant associations with mean NR index in all three groups. Sensitivity analysis showed that intraoperative mean NR index was higher in younger children than that in both older children and younger adults, and it gradually increased again in older adults to the same level as in younger children. In conclusion, there is likely an association between age and intraoperative mean NR index in patients under general anesthesia.
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Affiliation(s)
- Kazunori Miyamoto
- Department of Anesthesiology and Pain Medicine, Hyogo Medical University Faculty of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Hyogo, Japan
| | - Atsuto Saeki
- Department of Anesthesiology and Pain Medicine, Hyogo Medical University Faculty of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Hyogo, Japan
| | - Sachiko Oshita
- Department of Anesthesiology and Pain Medicine, Hyogo Medical University Faculty of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Hyogo, Japan
| | - Mayu Kobata
- Department of Anesthesiology and Pain Medicine, Hyogo Medical University Faculty of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Hyogo, Japan
| | - Rie Takami
- Department of Anesthesiology and Pain Medicine, Hyogo Medical University Faculty of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Hyogo, Japan
| | - Daimu Miyamoto
- Department of Anesthesiology and Pain Medicine, Hyogo Medical University Faculty of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Hyogo, Japan
| | - Hiroai Okutani
- Department of Anesthesiology and Pain Medicine, Hyogo Medical University Faculty of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Hyogo, Japan
| | - Ryusuke Ueki
- Department of Anesthesiology and Pain Medicine, Hyogo Medical University Faculty of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Hyogo, Japan
| | - Nobutaka Kariya
- Department of Anesthesiology and Pain Medicine, Hyogo Medical University Faculty of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Hyogo, Japan
| | - Munetaka Hirose
- Department of Anesthesiology and Pain Medicine, Hyogo Medical University Faculty of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Hyogo, Japan.
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Moharari RS, Emami P, Neishaboury M, Sharifnia SH, Kianpour P, Hatam M, Etezadi F, Khajavi M, Najafi A, Pourrashidi A, Pourfakhr P. Scalp Nerve Block for Enhanced Pain Control and Analgesic Optimization in Elective Craniotomy: A Randomized Controlled Trial with Analgesia Nociception Index Monitoring. World Neurosurg 2024:S1878-8750(24)00907-0. [PMID: 38821400 DOI: 10.1016/j.wneu.2024.05.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/21/2024] [Accepted: 05/22/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND In patients who are candidates for craniotomy, scalp nerve blocks have been shown to be effective in relieving pain intensity as well as postoperative hemodynamic stability after surgery, but the results have been inconsistent. We aimed to assess the effect of scalp block on pain control, intraoperative drug use under Analgesia Nociception Index (ANI) monitoring, and postoperative pain in patients who were candidates for elective craniotomy. METHODS In this randomized, single-blinded clinical trial study, candidates for craniotomy were randomly (using the block randomization method) divided into 2 groups before entering the operating room. The first group received a scalp block with bupivacaine (intervention), and the second group did not receive a scalp block (control) besides the routine anesthetic procedure in these patients. ANI, hemodynamic parameters, and the amounts of received remifentanil were conducted and compared. RESULTS Patients under scalp block received less dosage of fentanyl than the nonscalp block group (mean = 57.14 ± 15.59 mcg vs. 250.00 ± 65.04 mcg, respectively). Similarly, the dose of remifentanil required in the scalp block group was less (mean = 3.04 ± 1.95 mg and 5.54 ± 2.57 mg, respectively). No difference was observed in hemodynamic parameters such as blood pressure and heart rate (before, during, and after surgery). However, the group receiving scalp block had higher ANI means than the control group. CONCLUSIONS Scalp nerve block has an effective role in pain control (increasing ANI), consequently reducing the need for analgesic drugs such as fentanyl and remifentanil following craniotomy without changing the hemodynamic condition.
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Affiliation(s)
- Reza Shariat Moharari
- Anesthesia, Critical Care, and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Pardis Emami
- Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohamadreza Neishaboury
- Anesthesia, Critical Care, and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Hamidreza Sharifnia
- Anesthesia, Critical Care, and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Parisa Kianpour
- Anesthesia, Critical Care, and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Hatam
- Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Etezadi
- Anesthesia, Critical Care, and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Khajavi
- Anesthesia, Critical Care, and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Atabak Najafi
- Anesthesia, Critical Care, and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Pourrashidi
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Pejman Pourfakhr
- Anesthesia, Critical Care, and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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Ivascu R, Torsin LI, Hostiuc L, Nitipir C, Corneci D, Dutu M. The Surgical Stress Response and Anesthesia: A Narrative Review. J Clin Med 2024; 13:3017. [PMID: 38792558 PMCID: PMC11121777 DOI: 10.3390/jcm13103017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 04/28/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
The human physiological response "to stress" includes all metabolic and hormonal changes produced by a traumatic event at the micro or macro cellular levels. The main goal of the body's first response to trauma is to keep physiological homeostasis. The perioperative non-specific adaptation response can sometimes be detrimental and can produce systemic inflammatory response syndrome (SIRS), characterized by hypermetabolism and hyper catabolism. We performed a narrative review consisting of a description of the surgical stress response's categories of changes (neurohormonal and immunological response) followed by reviewing methods found in published studies to modulate the surgical stress response perioperatively. We described various preoperative measures cited in the literature as lowering the burden of surgical trauma. This article revises the anesthetic drugs and techniques that have an impact on the surgical stress response and proven immune-modulatory effects. We also tried to name present knowledge gaps requiring future research. Our review concludes that proper preoperative measures, adequate general anesthetics, multimodal analgesia, early postoperative mobilization, and early enteral nutrition can decrease the stress response to surgery and ease patient recovery. Anesthetics and analgesics used during the perioperative period may modulate the innate and adaptive immune system and inflammatory system, with a consecutive impact on cancer recurrence and long-term outcomes.
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Affiliation(s)
- Robert Ivascu
- Department of Anesthesiology and Intensive Care, Carol Davila University of Medicine and Pharmacy, 0200021 Bucharest, Romania; (R.I.); (D.C.)
- Department of Anesthesiology and Intensive Care, Dr. Carol Davila Central Military Emergency University Hospital, 010242 Bucharest, Romania; (L.I.T.); (L.H.)
| | - Ligia I. Torsin
- Department of Anesthesiology and Intensive Care, Dr. Carol Davila Central Military Emergency University Hospital, 010242 Bucharest, Romania; (L.I.T.); (L.H.)
| | - Laura Hostiuc
- Department of Anesthesiology and Intensive Care, Dr. Carol Davila Central Military Emergency University Hospital, 010242 Bucharest, Romania; (L.I.T.); (L.H.)
| | - Cornelia Nitipir
- Department of Oncology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Oncology, Elias University Emergency Hospital, 011461 Bucharest, Romania
| | - Dan Corneci
- Department of Anesthesiology and Intensive Care, Carol Davila University of Medicine and Pharmacy, 0200021 Bucharest, Romania; (R.I.); (D.C.)
- Department of Anesthesiology and Intensive Care, Dr. Carol Davila Central Military Emergency University Hospital, 010242 Bucharest, Romania; (L.I.T.); (L.H.)
| | - Madalina Dutu
- Department of Anesthesiology and Intensive Care, Carol Davila University of Medicine and Pharmacy, 0200021 Bucharest, Romania; (R.I.); (D.C.)
- Department of Anesthesiology and Intensive Care, Dr. Carol Davila Central Military Emergency University Hospital, 010242 Bucharest, Romania; (L.I.T.); (L.H.)
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13
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Wang TC, Li WY, Lai JCY, Kuo TBJ, Yang CCH. Nociception Effect on Frontal Electroencephalogram Waveform and Phase-Amplitude Coupling in Laparoscopic Surgery. Anesth Analg 2024; 138:1070-1080. [PMID: 37428681 DOI: 10.1213/ane.0000000000006609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
BACKGROUND Electroencephalographic pattern changes during anesthesia reflect the nociception-analgesia balance. Alpha dropout, delta arousal, and beta arousal with noxious stimulation have been described during anesthesia; however, data on the reaction of other electroencephalogram signatures toward nociception are scarce. Analyzing the effects of nociception on different electroencephalogram signatures may help us find new nociception markers in anesthesia and understand the neurophysiology of pain in the brain. This study aimed to analyze the electroencephalographic frequency pattern and phase-amplitude coupling change during laparoscopic surgeries. METHODS This study evaluated 34 patients who underwent laparoscopic surgery. The electroencephalogram frequency band power and phase-amplitude coupling of different frequencies were analyzed across 3 stages of laparoscopy: incision, insufflation, and opioid stages. Repeated-measures analysis of variance with a mixed model and the Bonferroni method for multiple comparisons were used to analyze the changes in the electroencephalogram signatures between the preincision and postincision/postinsufflation/postopioid phases. RESULTS During noxious stimulation, the frequency spectrum showed obvious decreases in the alpha power percentage after the incision (mean ± standard error of the mean [SEM], 26.27 ± 0.44 and 24.37 ± 0.66; P < .001) and insufflation stages (26.27 ± 0.44 and 24.40 ± 0.68; P = .002), which recovered after opioid administration. Further phase-amplitude analyses showed that the modulation index (MI) of the delta-alpha coupling decreased after the incision stage (1.83 ± 0.22 and 0.98 ± 0.14 [MI × 10 3 ]; P < .001), continued to be suppressed during the insufflation stage (1.83 ± 0.22 and 1.17 ± 0.15 [MI × 10 3 ]; P = .044), and recovered after opioid administration. CONCLUSIONS Alpha dropout during noxious stimulation is observed in laparoscopic surgeries under sevoflurane. In addition, the modulation index of delta-alpha coupling decreases during noxious stimulation and recovers after the administration of rescue opioids. Phase-amplitude coupling of the electroencephalogram may be a new approach for evaluating the nociception-analgesia balance during anesthesia.
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Affiliation(s)
- Tzu Chun Wang
- From the Department of Anaesthesia, Taitung MacKay Memorial Hospital, Taitung, Taiwan
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei Yi Li
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jerry Cheng-Yen Lai
- Department of Medical Research, Taitung MacKay Memorial Hospital, Taitung, Taiwan
- Master Program in Biomedicine, College of Science and Engineering, National Taitung University, Taitung, Taiwan
| | - Terry B J Kuo
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Sleep Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
- Tsoutun Psychiatric Center, Ministry of Health and Welfare, Nantou, Taiwan
| | - Cheryl C H Yang
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Sleep Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
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Ghezzi MD, Ceriani MC, Domínguez-Oliva A, Lendez PA, Olmos-Hernández A, Casas-Alvarado A, Hernández-Avalos I. Use of Infrared Thermography and Heart Rate Variability to Evaluate Autonomic Activity in Domestic Animals. Animals (Basel) 2024; 14:1366. [PMID: 38731370 PMCID: PMC11083326 DOI: 10.3390/ani14091366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 04/24/2024] [Accepted: 04/27/2024] [Indexed: 05/13/2024] Open
Abstract
Most of the responses present in animals when exposed to stressors are mediated by the autonomic nervous system. The sympathetic nervous system, known as the one responsible for the "fight or flight" reaction, triggers cardiovascular changes such as tachycardia or vasomotor alterations to restore homeostasis. Increase in body temperature in stressed animals also activates peripheral compensatory mechanisms such as cutaneous vasodilation to increase heat exchange. Since changes in skin blood flow influence the amount of heat dissipation, infrared thermography is suggested as a tool that can detect said changes. The present review aims to analyze the application of infrared thermography as a method to assess stress-related autonomic activity, and their association with the cardiovascular and heart rate variability in domestic animals.
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Affiliation(s)
- Marcelo Daniel Ghezzi
- Anatomy Area, Faculty of Veterinary Sciences (FCV), Universidad Nacional del Centro de la Provincia de Buenos Aires (UNCPBA), University Campus, Tandil 7000, Argentina
| | - María Carolina Ceriani
- Centro de Investigación Veterinaria de Tandil CIVETAN, UNCPBA-CICPBA-CONICET (UNCPBA), University Campus, Tandil 7000, Argentina
| | - Adriana Domínguez-Oliva
- Neurophysiology, Behavior and Animal Welfare Assessment, DPAA, Universidad Autónoma Metropolitana, Xochimilco Campus, Mexico City 04960, Mexico
| | - Pamela Anahí Lendez
- Anatomy Area, Faculty of Veterinary Sciences (FCV), Universidad Nacional del Centro de la Provincia de Buenos Aires (UNCPBA), University Campus, Tandil 7000, Argentina
- Centro de Investigación Veterinaria de Tandil CIVETAN, UNCPBA-CICPBA-CONICET (UNCPBA), University Campus, Tandil 7000, Argentina
| | - Adriana Olmos-Hernández
- Division of Biotechnology—Bioterio and Experimental Surgery, Instituto Nacional de Rehabilitación-Luis Guillermo Ibarra Ibarra (INR-LGII), Tlalpan, Mexico City 14389, Mexico
| | - Alejandro Casas-Alvarado
- Neurophysiology, Behavior and Animal Welfare Assessment, DPAA, Universidad Autónoma Metropolitana, Xochimilco Campus, Mexico City 04960, Mexico
| | - Ismael Hernández-Avalos
- Clinical Pharmacology and Veterinary Anesthesia, Facultad de Estudios Superiores Cuautitlán, Universidad Nacional Autónoma de México (UNAM), Cuautitlán Izcalli 54714, Mexico
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15
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Likar R, Köstenberger M. [Developments in anesthesia : Thinking outside the box is worthwhile!]. DIE ANAESTHESIOLOGIE 2024; 73:221-222. [PMID: 38625540 DOI: 10.1007/s00101-024-01399-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 04/17/2024]
Affiliation(s)
- Rudolf Likar
- Abteilung für Anästhesiologie, allgemeine Intensivmedizin, Notfallmedizin, interdisziplinäre Schmerztherapie und Palliativmedizin, Klinikum Klagenfurt am Wörthersee, Landeskrankenanstalten-Betriebsgesellschaft - KABEG, Klagenfurt am Wörthersee, Österreich
| | - Markus Köstenberger
- Abteilung für Anästhesiologie, allgemeine Intensivmedizin, Notfallmedizin, interdisziplinäre Schmerztherapie und Palliativmedizin, Klinikum Klagenfurt am Wörthersee, Landeskrankenanstalten-Betriebsgesellschaft - KABEG, Klagenfurt am Wörthersee, Österreich.
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16
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Coeckelenbergh S, Boelefahr S, Alexander B, Perrin L, Rinehart J, Joosten A, Barvais L. Closed-loop anesthesia: foundations and applications in contemporary perioperative medicine. J Clin Monit Comput 2024; 38:487-504. [PMID: 38184504 DOI: 10.1007/s10877-023-01111-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 11/21/2023] [Indexed: 01/08/2024]
Abstract
A closed-loop automatically controls a variable using the principle of feedback. Automation within anesthesia typically aims to improve the stability of a controlled variable and reduce workload associated with simple repetitive tasks. This approach attempts to limit errors due to distractions or fatigue while simultaneously increasing compliance to evidence based perioperative protocols. The ultimate goal is to use these advantages over manual care to improve patient outcome. For more than twenty years, clinical studies in anesthesia have demonstrated the superiority of closed-loop systems compared to manual control for stabilizing a single variable, reducing practitioner workload, and safely administering therapies. This research has focused on various closed-loops that coupled inputs and outputs such as the processed electroencephalogram with propofol, blood pressure with vasopressors, and dynamic predictors of fluid responsiveness with fluid therapy. Recently, multiple simultaneous independent closed-loop systems have been tested in practice and one study has demonstrated a clinical benefit on postoperative cognitive dysfunction. Despite their advantages, these tools still require that a well-trained practitioner maintains situation awareness, understands how closed-loop systems react to each variable, and is ready to retake control if the closed-loop systems fail. In the future, multiple input multiple output closed-loop systems will control anesthetic, fluid and vasopressor titration and may perhaps integrate other key systems, such as the anesthesia machine. Human supervision will nonetheless always be indispensable as situation awareness, communication, and prediction of events remain irreplaceable human factors.
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Affiliation(s)
- Sean Coeckelenbergh
- Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Saclay, Université Paris-Saclay, Hôpital Paul-Brousse, Assistance Publique Hôpitaux de Paris, Villejuif, France.
- Outcomes Research Consortium, Cleveland, OH, USA.
| | - Sebastian Boelefahr
- Department of Anesthesiology and Intensive Care, Klinikum Aschaffenburg-Alzenau, Frankfurt University and Wuerzburg University Affiliated Academic Training Hospital, Aschaffenburg, Germany
| | - Brenton Alexander
- Department of Anesthesiology & Perioperative Care, University of California San Diego, San Diego, CA, USA
| | - Laurent Perrin
- Department of Anaesthesia and Resuscitation, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Joseph Rinehart
- Outcomes Research Consortium, Cleveland, OH, USA
- Department of Anesthesiology & Perioperative Care, University of California Irvine, Irvine, CA, USA
| | - Alexandre Joosten
- Department of Anesthesiology & Perioperative Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Luc Barvais
- Department of Anaesthesia and Resuscitation, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
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17
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Konno M, Niwa H, Kitayama M, Hirota K. Video versus ultrasound pupillometry for detecting increased pupillary diameters due to nociceptive stimuli: a prospective observational study. J Anesth 2024; 38:191-197. [PMID: 38189944 DOI: 10.1007/s00540-023-03297-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 12/06/2023] [Indexed: 01/09/2024]
Abstract
PURPOSE Ultrasound pupillometry (UP) is a potential alternative to video pupillometry (VP) for assessing changes in patients' pupillary diameter (ΔPD) due to surgical nociception, but the reproducibility of UP and VP has been unclear. We evaluated the reproducibility of nociceptive ΔPD measured with both methods. SUBJECTS AND METHODS This prospective observational trial with 15 healthy volunteers aged ≥ 18 years was conducted at a Japanese teaching hospital. The ΔPD due to tetanic stimuli randomly applied at 10-60 mA was measured with VP and UP. The primary outcome was the correlation between the ΔPD measured with VP and that measured with UP. The secondary outcome was the agreement between the methods. We also evaluated ΔPD pattern changes due to the raised pain intensity in each method. RESULTS The noxious ΔPD values of UP were weakly but significantly correlated with those of VP (Spearman's ρ = 0.38, p < 0.001). A significant constant error was identified between the two measurements (Bland-Altman: mean of the difference in ΔPD (VP - UP), - 0.4 [95% CI: - 0.52 to - 0.28, p < 0.001], generalized estimating equation: a beta estimator of ΔPD: 0.41, [95% CI: 0.26-0.56, p < 0.001]). The ΔPD pattern changes due to the raised tetanic stimuli were almost the same in the two methods. CONCLUSION Due to the significant constant error, we consider the reproducibility of the measured ΔPD between UP and VP moderate. Trial registry number UMIN 000047145. Prior to the subjects' enrollment, the trial was registered with the University Hospital Medical Information Network (Principal investigator: Mao Konno, Date of registration: 3.11.2022). https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000053778 .
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Affiliation(s)
- Mao Konno
- Department of Anesthesiology, Hirosaki University Hospital, 53 Honcho, Hirosaki, Aomori, 036-8563, Japan
| | - Hidetomo Niwa
- Department of Community Medicine for Perioperative Management, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki, Aomori, 036-8562, Japan.
| | - Masato Kitayama
- Department of Surgery, Hirosaki University Hospital, 53 Honcho, Hirosaki, Aomori, 036-8563, Japan
| | - Kazuyoshi Hirota
- Department of Community Medicine for Perioperative Management, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki, Aomori, 036-8562, Japan
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki, Aomori, 036-8562, Japan
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Xu J, Smaling HJA, Schoones JW, Achterberg WP, van der Steen JT. Noninvasive monitoring technologies to identify discomfort and distressing symptoms in persons with limited communication at the end of life: a scoping review. BMC Palliat Care 2024; 23:78. [PMID: 38515049 PMCID: PMC10956214 DOI: 10.1186/s12904-024-01371-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/29/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Discomfort and distressing symptoms are common at the end of life, while people in this stage are often no longer able to express themselves. Technologies may aid clinicians in detecting and treating these symptoms to improve end-of-life care. This review provides an overview of noninvasive monitoring technologies that may be applied to persons with limited communication at the end of life to identify discomfort. METHODS A systematic search was performed in nine databases, and experts were consulted. Manuscripts were included if they were written in English, Dutch, German, French, Japanese or Chinese, if the monitoring technology measured discomfort or distressing symptoms, was noninvasive, could be continuously administered for 4 hours and was potentially applicable for bed-ridden people. The screening was performed by two researchers independently. Information about the technology, its clinimetrics (validity, reliability, sensitivity, specificity, responsiveness), acceptability, and feasibility were extracted. RESULTS Of the 3,414 identified manuscripts, 229 met the eligibility criteria. A variety of monitoring technologies were identified, including actigraphy, brain activity monitoring, electrocardiography, electrodermal activity monitoring, surface electromyography, incontinence sensors, multimodal systems, and noncontact monitoring systems. The main indicators of discomfort monitored by these technologies were sleep, level of consciousness, risk of pressure ulcers, urinary incontinence, agitation, and pain. For the end-of-life phase, brain activity monitors could be helpful and acceptable to monitor the level of consciousness during palliative sedation. However, no manuscripts have reported on the clinimetrics, feasibility, and acceptability of the other technologies for the end-of-life phase. CONCLUSIONS Noninvasive monitoring technologies are available to measure common symptoms at the end of life. Future research should evaluate the quality of evidence provided by existing studies and investigate the feasibility, acceptability, and usefulness of these technologies in the end-of-life setting. Guidelines for studies on healthcare technologies should be better implemented and further developed.
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Affiliation(s)
- Jingyuan Xu
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Gebouw 3, Postzone V0-P, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Hanneke J A Smaling
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Gebouw 3, Postzone V0-P, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
- University Network for the Care Sector Zuid-Holland, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan W Schoones
- Directorate of Research Policy, Leiden University Medical Center, Leiden, The Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Gebouw 3, Postzone V0-P, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
- University Network for the Care Sector Zuid-Holland, Leiden University Medical Center, Leiden, The Netherlands
| | - Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Gebouw 3, Postzone V0-P, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
- Department of Primary and Community Care, and Radboudumc Alzheimer Center, Radboud university medical center, Nijmegen, The Netherlands
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Kościuczuk U, Tarnowska K, Rynkiewicz-Szczepanska E. Are There Any Advantages of the Low Opioid Anaesthesia and Non-Opioid Postoperative Analgesia Protocol: A Clinical Observational Study. J Pain Res 2024; 17:941-951. [PMID: 38476874 PMCID: PMC10929647 DOI: 10.2147/jpr.s449563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/23/2024] [Indexed: 03/14/2024] Open
Abstract
Purpose The methods of perioperative analgesia and pain control have changed. The principle of opioid-based analgesia has been modified to multimodal analgesia, followed by LOA (low opioid anaesthesia) and OFA (opioid-free anaesthesia). The aim was to describe the effects of LOA on nausea, vomiting, and pain control during general anaesthesia and postoperative period after laparoscopic cholecystectomy. Patients and Methods The protocol included the study group-40 patients received low-opioid anaesthesia (LOA), and the control group-40 patients received general anaesthesia with opioid analgesia (OA). The scheme of LOA was based on ketamine, lidocaine, magnesium sulfate, paracetamol, and metamizole. The OA was based on standard opioid (fentanyl) administration in induction and maintenance phase due to clinical observation. Postoperative analgesia included 1g of paracetamol and 1g of metamizol intravenously, with a 6-hour interval between doses. Results Significant differences in the pain score in the periods of 2-6, 6-12, and 12-24 hours after anaesthesia between the groups were noticed (p < 0.001). Moreover, a significant difference in the frequency of nausea (p = 0.005) and vomiting (p = 0.04) between groups were presented. Nausea occurred in 54.05% of OA group, while in the LOA group, it occurred in a 23.08%. Vomiting occurred in 32.43% of control group, while in the study group, it occurred in 12.82% of patients. Conclusion The LOA protocol was more beneficial in reducing nausea and vomiting than the opioid-based method of anaesthesia. The LOA protocol of general anaesthesia during laparoscopic cholecystectomy and non-opioid postoperative analgesia have better outcomes in pain control, as well as nausea and vomiting, and improve postoperative patient comfort. The LOA protocol during anaesthesia and non-opioid postoperative analgesia should be considered in routine practice.
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Affiliation(s)
- Urszula Kościuczuk
- Department of Anaesthesiology and Intensive Therapy, Medical University in Bialystok, Bialystok, Poland
| | - Katarzyna Tarnowska
- Department of Anaesthesiology and Intensive Therapy, Medical University in Bialystok, Bialystok, Poland
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Rogozov V, Vanek T, Maly M, Rocek J, Kacer P. The nociceptive response during adult cardiac surgery measured by the qNOX index: A feasibility study. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2024; 168:62-67. [PMID: 36321735 DOI: 10.5507/bp.2022.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 10/18/2022] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Monitoring nociception during general anaesthesia remains a substantial challenge. The Conox monitor uses two EEG indices, the qCon and the qNox. The qNox refers to the probability that a nociceptive stimulation triggers a movement of the patient and the response probability of reaction to nociceptive stimulation. We decided to test the feasibility of monitoring the qNOX index during adult cardiac surgery and to investigate whether this index correlates with hemodynamic and hormonal signs of nociceptive stimulation. METHOD We enrolled 19 patients undergoing elective cardiac surgery. These were randomised to 2 groups receiving different doses of sufentanil via target controlled infusion: group A (n=9) 0.25 ng/mL and group B (n=10) 0.75 ng/mL. All patients were maintained at the same depth of anaesthesia. We recorded the Conox monitor indices (qNOX, qCON, electromyographic), hemodynamic variables and plasmatic levels of cortisol and noradrenaline. RESULTS There was significantly higher blood pressure (P=0.013) and plasmatic cortisol (P=0.003) in group A and a significant increase in plasmatic noradrenaline with increasing intensity of surgical stimulation in both groups: A (P=0.001), B (P=0.008). We found no significant corresponding changes in the qNOX index. There was a positive correlation between qNOX and hemodynamic signs of stimulation (P=0.012) and between the qNOX and EMG indices (P=0.013) after endotracheal intubation, but not later after EMG index dropped. CONCLUSION Our results do not support the assumption that signs of nociceptive stimulation during adult cardiac surgery will be reflected by the qNOX index. This may be related to compounding of qNOX processing and use of muscle relaxants. Further investigation on this field is needed.
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Affiliation(s)
- Vladislav Rogozov
- Department of Cardiac Surgery, 3rd Faculty of Medicine, Charles University, Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
- Department of Anaesthesia, Leeds Teaching Hospitals, United Kingdom
| | - Tomas Vanek
- Department of Cardiac Surgery, 3rd Faculty of Medicine, Charles University, Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Marek Maly
- National Institute of Public Health, Prague, Czech Republic
| | - Jan Rocek
- Department of Cardiac Surgery, 3rd Faculty of Medicine, Charles University, Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Petr Kacer
- Department of Cardiac Surgery, 3rd Faculty of Medicine, Charles University, Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
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Stasiowski MJ, Lyssek-Boroń A, Kawka-Osuch M, Niewiadomska E, Grabarek BO. Possibility of Using Surgical Pleth Index in Predicting Postoperative Pain in Patients after Vitrectomy Performed under General Anesthesia. Diagnostics (Basel) 2024; 14:425. [PMID: 38396464 PMCID: PMC10887804 DOI: 10.3390/diagnostics14040425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
Adequacy of anesthesia concept (AoA) in the guidance of general anesthesia (GA) is based on entropy, and it also reflects the actual depth of anesthesia and the surgical pleth index (SPI). Therefore, this study aimed to analyze the potential existence of relationships between SPI values at certain stages of the AoA-guided GA for vitreoretinal surgeries (VRS) and the incidence of intolerable postoperative pain perception (IPPP). A total of 175 patients were each assigned to one of five groups. In the first, the VRS procedure was performed under GA without premedication; in the second group, patients received metamizole before GA; in the third, patients received acetaminophen before GA; in the fourth group, patients received Alcaine before GA; and, in the peribulbar block group, the patients received a peribulbar block with a mix of the solutions of lignocaine and bupivacaine. Between the patients declaring mild and statistically significant differences in the IPPP in terms of SPI values before induction (52.3 ± 18.8 vs. 63.9 ± 18.1, p < 0.05) and after emergence from GA (51.1 ± 13 vs. 68.1 ± 8.8; p < 0.001), it was observed that the patients postoperatively correlated with heart rate variations despite the group allocation. The current study proves the feasibility that preoperative SPI values help with predicting IPPP immediately after VRS under AoA guidance and discrimination (between mild diagnoses and IPPP when based on postoperative SPI values) as they correlate with heart rate variations. Specifically, this applies when the countermeasures of IPPP and hemodynamic fluctuations are understood to be of importance in reducing unwelcome adverse events.
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Affiliation(s)
- Michał Jan Stasiowski
- Chair and Department of Emergency Medicine, Division of Medical Sciences in Zabrze, Medical University of Silesia, 40-555 Katowice, Poland
- Department of Anaesthesiology and Intensive Care, 5th Regional Hospital, Trauma Centre, 41-200 Sosnowiec, Poland
| | - Anita Lyssek-Boroń
- Department of Ophthalmology with Paediatric Unit, 5th Regional Hospital, 41-200 Sosnowiec, Poland; (A.L.-B.); (M.K.-O.)
- Department of Ophthalmology, Faculty of Medicine in Zabrze, Academy of Silesia, 40-555 Katowice, Poland
| | - Magdalena Kawka-Osuch
- Department of Ophthalmology with Paediatric Unit, 5th Regional Hospital, 41-200 Sosnowiec, Poland; (A.L.-B.); (M.K.-O.)
| | - Ewa Niewiadomska
- Department of Epidemiology and Biostatistics, School of Public Health in Bytom, Medical University of Silesia, 40-555 Katowice, Poland;
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22
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Lee C, Lee C, Lim J, Park J, Jung J, Lee H, Lee M. The Relationship between Pre-Anesthetic Analgesia and Nociception (ANI) and Propofol Injection Pain among Patients Receiving Remifentanil: A Prospective, Randomized, Controlled Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:273. [PMID: 38399560 PMCID: PMC10889958 DOI: 10.3390/medicina60020273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/23/2024] [Accepted: 01/31/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: The analgesia/nociception index (ANI) potentially monitors nociceptive status during anesthesia, but its link to preoperative pain sensitivity is unclear. We investigated the relationship between pre-anesthetic ANI scores and propofol injection pain (PIP) in patients receiving remifentanil. Materials and Methods: This study included 124 male patients aged 19-60 undergoing general anesthesia (ASA class I or II). Patients were randomized to group R (n = 62, remifentanil 4 ng/mL) or group C (n = 62, saline). The primary outcome was the association between PIP and ANI. Secondary outcomes included the incidence and severity of PIP or rocuronium-induced withdrawal movement (RIWM) and their association with ANI. Results: PIP and RIWM incidence and severity were lower in group R than in group C. A weak negative correlation between PIP and ANI at pre-induction (rpb = -0.21, p = 0.02, rpb = -0.37, p < 0.01) and a moderate negative correlation during propofol injection (rpb = -0.48, p = 0.02) were observed. A significant negative correlation was found between RIWM and ANI during rocuronium injection (τb = -0.61, p < 0.01). AUC, cut-off value, specificity, and sensitivity in ANI at pre-induction for predicting PIP were 0.67 (p = 0.02), 59, 76%, and 55%, respectively. AUC, cut-off value, specificity, and sensitivity in ANI during propofol injection for PIP were 0.77 (p < 0.01), 65, 81%, and 67%, respectively. Conclusions: ANI scores demonstrated significant differences between groups, suggesting potential predictive value for PIP despite the low pre-induction AUC value. This study highlights the potential of using ANI scores to predict and manage PIP in patients receiving remifentanil.
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Affiliation(s)
- Cheolhyeong Lee
- Department of Anesthesiology and Pain Medicine, Wonkwang University School of Medicine Hospital, 895 Muwang-ro, Iksan 54538, Republic of Korea; (C.L.); (J.L.); (J.P.)
| | - Cheol Lee
- Department of Anesthesiology and Pain Medicine, Wonkwang University School of Medicine Hospital, 895 Muwang-ro, Iksan 54538, Republic of Korea; (C.L.); (J.L.); (J.P.)
| | - Junsung Lim
- Department of Anesthesiology and Pain Medicine, Wonkwang University School of Medicine Hospital, 895 Muwang-ro, Iksan 54538, Republic of Korea; (C.L.); (J.L.); (J.P.)
| | - Jeongki Park
- Department of Anesthesiology and Pain Medicine, Wonkwang University School of Medicine Hospital, 895 Muwang-ro, Iksan 54538, Republic of Korea; (C.L.); (J.L.); (J.P.)
| | - Jaehak Jung
- Department of Obstetrics and Gynecology, Wonkwang University School of Medicine Hospital, 895 Muwang-ro, Iksan 54538, Republic of Korea
| | - Hayoung Lee
- Department of Nursing, Wonkwang University School of Medicine Hospital, 895 Muwang-ro, Iksan 54538, Republic of Korea;
| | - Myeongjong Lee
- Department of Anesthesiology and Pain Medicine, Konkuk University Medical School, 82 Gugwondae-ro, Chungju 27376, Republic of Korea;
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23
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Ryalino C, Sahinovic MM, Drost G, Absalom AR. Intraoperative monitoring of the central and peripheral nervous systems: a narrative review. Br J Anaesth 2024; 132:285-299. [PMID: 38114354 DOI: 10.1016/j.bja.2023.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 11/03/2023] [Accepted: 11/03/2023] [Indexed: 12/21/2023] Open
Abstract
The central and peripheral nervous systems are the primary target organs during anaesthesia. At the time of the inception of the British Journal of Anaesthesia, monitoring of the central nervous system comprised clinical observation, which provided only limited information. During the 100 yr since then, and particularly in the past few decades, significant progress has been made, providing anaesthetists with tools to obtain real-time assessments of cerebral neurophysiology during surgical procedures. In this narrative review article, we discuss the rationale and uses of electroencephalography, evoked potentials, near-infrared spectroscopy, and transcranial Doppler ultrasonography for intraoperative monitoring of the central and peripheral nervous systems.
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Affiliation(s)
- Christopher Ryalino
- Department of Anaesthesiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Marko M Sahinovic
- Department of Anaesthesiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Gea Drost
- Department of Neurology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands; Department of Neurosurgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Anthony R Absalom
- Department of Anaesthesiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
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24
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Oh SK, Won YJ, Lim BG. Surgical pleth index monitoring in perioperative pain management: usefulness and limitations. Korean J Anesthesiol 2024; 77:31-45. [PMID: 36926752 PMCID: PMC10834712 DOI: 10.4097/kja.23158] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/16/2023] [Accepted: 03/16/2023] [Indexed: 03/18/2023] Open
Abstract
Surgical pleth index (SPI) monitoring is a representative, objective nociception-monitoring device that measures nociception using photoplethysmographic signals. It is easy to apply to patients and the numerical calculation formula is intuitively easy to understand; therefore, its clinical interpretation is simple. Several studies have demonstrated its efficacy and utility. Compared with hemodynamic parameters, the SPI can detect the degree of nociception during surgery under general anesthesia with greater accuracy, and therefore can provide better guidance for the administration of various opioids, including remifentanil, fentanyl, and sufentanil. Indeed, SPI-guided analgesia is associated with lower intraoperative opioid consumption, faster patient recovery, and comparable or lower levels of postoperative pain and rates of adverse events compared with conventional analgesia. In addition, SPI monitoring allows for the degree of postoperative pain and analgesic requirements to be predicted through the SPI values immediately before patient arousal. However, because patient age, effective circulating volume, position, concomitant medication and anesthetic regimen and level of consciousness may be confounding factors in SPI monitoring, clinicians must be careful when interpreting SPI values. In addition, as SPI values can differ depending on anesthetic and analgesic regimens and the underlying disease, an awareness of the effects of these variables with an understanding of the advantages and disadvantages of SPI monitoring compared to other nociception monitoring devices is essential. Therefore, this review aimed to help clinicians perform optimal SPI-guided analgesia and to assist with the establishment of future research designs through clarifying current usefulness and limitations of SPI monitoring in perioperative pain management.
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Affiliation(s)
- Seok Kyeong Oh
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Young Ju Won
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Byung Gun Lim
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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25
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Stasiowski MJ, Lyssek-Boroń A, Zmarzły N, Marczak K, Grabarek BO. The Adequacy of Anesthesia Guidance for Vitreoretinal Surgeries with Preemptive Paracetamol/Metamizole. Pharmaceuticals (Basel) 2024; 17:129. [PMID: 38256962 PMCID: PMC10819548 DOI: 10.3390/ph17010129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/09/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
Despite the possibility of postoperative pain occurrence, in some patients, vitreoretinal surgeries (VRSs) require performance of general anesthesia (GA). The administration of intraoperative intravenous rescue opioid analgesics (IROA) during GA constitutes a risk of perioperative adverse events. The Adequacy of Anesthesia (AoA) concept consists of an entropy electroencephalogram to guide the depth of GA and surgical pleth index (SPI) to optimize the titration of IROA. Preemptive analgesia (PA) using cyclooxygenase-3 (COX-3) inhibitors is added to GA to minimize the demand for IROA and reduce postoperative pain. The current analysis evaluated the advantage of PA using COX-3 inhibitors added to GA with AoA-guided administration of IROA on the rate of postoperative pain and hemodynamic stability in patients undergoing VRS. A total of 165 patients undergoing VRS were randomly allocated to receive either GA with AoA-guided IROA administration with intravenous paracetamol/metamizole or with preemptive paracetamol or metamizole. Preemptive paracetamol resulted in a reduction in the IROA requirement; both preemptive metamizole/paracetamol resulted in a reduced rate of postoperative pain as compared to metamizole alone. We recommend using intraoperative AOA-guided IROA administration during VRS to ensure hemodynamic stability alongside PA using both paracetamol/metamizole to reduce postoperative pain.
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Affiliation(s)
- Michał Jan Stasiowski
- Chair and Department of Emergency Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
- Department of Anaesthesiology and Intensive Care, 5th Regional Hospital, Trauma Centre, 41-200 Sosnowiec, Poland;
| | - Anita Lyssek-Boroń
- Department of Ophthalmology with Paediatric Unit, 5th Regional Hospital, Trauma Centre, 41-200 Sosnowiec, Poland;
- Department of Ophthalmology, Faculty of Medicine, Academy of Silesia, 40-055 Katowice, Poland
| | - Nikola Zmarzły
- Collegium Medicum, WSB University, 41-300 Dabrowa Gornicza, Poland; (N.Z.); (B.O.G.)
| | - Kaja Marczak
- Department of Anaesthesiology and Intensive Care, 5th Regional Hospital, Trauma Centre, 41-200 Sosnowiec, Poland;
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26
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Zarnegar R, Vounta A, Li Q, Ghoreishizadeh SS. Nociception related biomolecules in the adult human saliva: A scoping review with additional quantitative focus on cortisol. Mol Pain 2024; 20:17448069241237121. [PMID: 38385158 PMCID: PMC10916496 DOI: 10.1177/17448069241237121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/30/2024] [Accepted: 02/15/2024] [Indexed: 02/23/2024] Open
Abstract
Nociception related salivary biomolecules can be useful patients who are not able to self-report pain. We present the existing evidence on this topic using the PRISMA-ScR guidelines and a more focused analysis of cortisol change after cold pain induction using the direction of effect analysis combined with risk of bias analysis using ROBINS-I. Five data bases were searched systematically for articles on adults with acute pain secondary to disease, injury, or experimentally induced pain. Forty three articles met the inclusion criteria for the general review and 11 of these were included in the cortisol-cold pain analysis. Salivary melatonin, kallikreins, pro-inflammatory cytokines, soluable TNF-α receptor II, secretory IgA, testosterone, salivary α-amylase (sAA) and, most commonly, cortisol have been studied in relation to acute pain. There is greatest information about cortisol and sAA which both rise after cold pain when compared with other modalities. Where participants have been subjected to both pain and stress, stress is consistently a more reliable predictor of salivary biomarker change than pain. There remain considerable challenges in identifying biomarkers that can be used in clinical practice to guide the measurement of nociception and treatment of pain. Standardization of methodology and researchers' greater awareness of the factors that affect salivary biomolecule concentrations are needed to improve our understanding of this field towards creating a clinically relevant body of evidence.
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Affiliation(s)
- Roxaneh Zarnegar
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Angeliki Vounta
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK
| | - Qiuyuan Li
- Department of Rehabilitation, Shenzhen University General Hospital, Shenzhen, China
| | - Sara S Ghoreishizadeh
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK
- Department of Electronic and Electrical Engineering, University College London, London, UK
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27
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Kongsgaard UE, Menchini RJ, Larsen SG, Juul-Hansen KE. Skin conductance algesimeter is unreliable during sudden perioperative temperature increases. Scand J Pain 2024; 24:sjpain-2023-0106. [PMID: 38607365 DOI: 10.1515/sjpain-2023-0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 03/25/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVES Pain assessment in anesthetized and non-communicative patients remains a challenge. Clinical signs such as tachycardia, hypertension, sweat and tears, have a low specificity for pain and should therefore ideally be replaced by more specific monitoring techniques. Skin conductance variability has been demonstrated to establish a patients' sensitivity to pain, but may be influenced by temperature changes that leads to profuse sweating. The aim of this pilot study was to test skin conductance changes during sudden temperature changes due to hyperthermic intraperitoneal chemotherapy (HIPEC) perfusation. METHODS We investigated skin conductance algesimeter (SCA) in ten consecutive patients undergoing cytoreductive surgery and HIPEC. Results from the SCA was compared to other standard physiological variables at seven time points during the surgical procedure, in particular during the period with hyperthermic intraabdominal perfusion leading to an increase in the patients core temperature. RESULTS Nine out of ten patients had an increase in the SCA measurements during the HIPEC phase correlating the increase in temperature. CONCLUSION SCA is unreliable to detect increased pain sensation during sudden perioperative temperature changes in adult patients.
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Affiliation(s)
- Ulf E Kongsgaard
- Department of Anaesthesia, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Robin Johansen Menchini
- Department of Anaesthesia, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Stein Gunnar Larsen
- Department of Gastroenterological Surgery, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Knut Erling Juul-Hansen
- Department of Anaesthesia, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
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28
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Fang F, Liu T, Li J, Yang Y, Hang W, Yan D, Ye S, Wu P, Hu Y, Hu Z. A novel nomogram for predicting the prolonged length of stay in post-anesthesia care unit after elective operation. BMC Anesthesiol 2023; 23:404. [PMID: 38062380 PMCID: PMC10702030 DOI: 10.1186/s12871-023-02365-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Prolonged length of stay in post-anesthesia care unit (PLOS in PACU) is a combination of risk factors and complications that can compromise quality of care and operating room efficiency. Our study aimed to develop a nomogram to predict PLOS in PACU of patients undergoing elective surgery. METHODS Data from 24017 patients were collected. Least absolute shrinkage and selection operator (LASSO) was used to screen variables. A logistic regression model was built on variables determined by a combined method of forward selection and backward elimination. Nomogram was designed with the model. The nomogram performance was evaluated with the area under the receiver operating characteristic curve (AUC) for discrimination, calibration plot for consistency between predictions and actuality, and decision curve analysis (DCA) for clinical application value. RESULTS A nomogram was established based on the selected ten variables, including age, BMI < 21 kg/m2, American society of Anesthesiologists Physical Status (ASA), surgery type, chill, delirium, pain, naloxone, operation duration and blood transfusion. The C-index value was 0.773 [95% confidence interval (CI) = 0.765 - 0.781] in the development set and 0.757 (95% CI = 0.744-0.770) in the validation set. The AUC was > 0.75 for the prediction of PLOS in PACU. The calibration curves revealed high consistencies between the predicted and actual probability. The DCA showed that if the threshold probability is over 10% , using the models to predict PLOS in PACU and implement intervention adds more benefit. CONCLUSIONS This study presented a nomogram to facilitate individualized prediction of PLOS in PACU for patients undergoing elective surgery.
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Affiliation(s)
- Fuquan Fang
- Department of Anesthesiology, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, China
| | - Tiantian Liu
- Department of Anesthesiology, Ningbo Women and Children's Hospital, Ningbo, Zhejiang, China
| | - Jun Li
- Department of Anesthesiology, Shulan Hangzhou Hospital, Hangzhou, China
| | - Yanchang Yang
- Department of Anesthesiology, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, China
| | - Wenxin Hang
- Department of Anesthesiology, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, China
| | - Dandan Yan
- Department of Anesthesiology, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, China
| | - Sujuan Ye
- Department of Anesthesiology, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, China
| | - Pin Wu
- Department of Anesthesiology, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, China
| | - Yuhan Hu
- Cell Biology Department, Yale University, New Haven, CT, USA
| | - Zhiyong Hu
- Department of Anesthesiology, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, China.
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29
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Yang L, Wang X, Wen H. Evaluation of the effectiveness of analgesia nociception index (ANI) predictability for surgical stimuli under personal analgesic sufficiency status (PASS) measured by pre-tetanus-induced ANI: a pilot study. J Clin Monit Comput 2023; 37:1585-1591. [PMID: 37418059 DOI: 10.1007/s10877-023-01044-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 06/09/2023] [Indexed: 07/08/2023]
Abstract
The Analgesia Nociception Index (ANI) is a promising monitor to evaluate the balance of nociception and anti-nociception based on heart rate variability. This prospective, interventional, monocentric pilot study aimed to verify the effectiveness of the personal analgesic sufficiency status (PASS) measured by pre-tetanus-induced ANI variation for surgical stimuli. After Ethics approval and informed consent, participants were anesthetized with sevoflurane and increased effect-site concentrations of remifentanil step by step (2, 4, 6 ng ml-1). At each concentration, a standardized tetanic stimulus was applied (5 s, 60 mA, 50 Hz) with no other noxious stimuli presented. Through all the concentrations, defined the lowest concentration when ANI ≥ 50 as the PASS after tetanic stimuli. The surgical stimulus was conducted under at least 5-min of PASS. Thirty-two participants were analyzed. ANI, systolic blood pressure (SBP), and Heart rate (HR) except the Bispectral Index (BIS) were significantly changed at 2 ng ml-1 after tetanic stimuli, only ANI and SBP were significantly altered at 4 and 6 ng ml-1. ANI could predict inadequate analgesia status (an increase in SBP or HR of more than 20% from the baseline) at 2 and 4 ng ml-1 (P = 0.044, P = 0.049, respectively), but not at 6 ng ml-1. The PASS under pre-tetanus-induced ANI identification didn't meet the analgesic needs under surgical stimuli. Further investigations are required to provide a reliable prediction of individualized analgesia by objective nociception monitors.Trial registration NCT05063461.
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Affiliation(s)
- Lina Yang
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China
| | - Xiaojie Wang
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China
| | - Hong Wen
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China.
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30
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Bornemann-Cimenti H, Lang-Illievich K, Kovalevska K, Brenna CTA, Klivinyi C. Effect of nociception level index-guided intra-operative analgesia on early postoperative pain and opioid consumption: a systematic review and meta-analysis. Anaesthesia 2023; 78:1493-1501. [PMID: 37864430 DOI: 10.1111/anae.16148] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 10/22/2023]
Abstract
Acute postoperative pain remains a critical treatment priority and has prompted a search for technologies and techniques to assist with intra-operative analgesic monitoring and management. Anaesthetists traditionally rely on clinical judgement to guide intra-operative analgesia, but several emerging technologies such as the nociception level index herald the possibility of routine intra-operative analgesia monitoring. However, the impact of devices like nociception level index on postoperative outcomes has not been proven. We undertook a systematic review and meta-analysis of articles which compared nociception level index-guided analgesia to standard care. The primary outcomes were pain intensity and opioid consumption during the first 60-120 min after surgery. Secondary outcomes were the incidence of postoperative nausea and vomiting and duration of stay in the post-anaesthesia care unit. Ten studies, collectively including 662 patients and published between 2019 and 2023, met inclusion criteria for both the qualitative systematic review and quantitative meta-analysis. Risk of methodological bias was generally low or unclear, and six studies reported a significant conflict of interest relevant to their findings. Our meta-analysis was performed using a random-effects model. It found statistically significant benefits of nociception level index-guided analgesia for early postoperative pain (mean (95%CI) difference -0.46 (-0.88 to -0.03) on an 11-point scale, p = 0.03), and opioid requirement (mean (95%CI) difference -1.04 (-1.94 to -0.15) mg intravenous morphine equivalent, p = 0.02). Our meta-analysis of the current literature finds that nociception level index-guided analgesia statistically significantly reduces reported postoperative pain intensity and opioid consumption but fails to show clinically relevant outcomes. We found no evidence that nociception level index-guided analgesia affected postoperative nausea and vomiting nor duration of stay in the post-anaesthesia care unit.
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Affiliation(s)
- H Bornemann-Cimenti
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - K Lang-Illievich
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - K Kovalevska
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - C T A Brenna
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - C Klivinyi
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
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Yu L, Yang Y, Wu H, Yu Y, Wang Y, Yan S, Li N, Li H, Chen C, Zhang Z. Pupillary monitoring decreases remifentanil consumption during laparoscopic uterine surgery and improves postoperative recovery. Minerva Anestesiol 2023; 89:859-866. [PMID: 37307030 DOI: 10.23736/s0375-9393.23.17303-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND The aim of this paper was to explore pupillary monitoring for determining remifentanil consumption during general anesthesia and evaluating postoperative recovery quality. METHODS Eighty patients undergoing elective laparoscopic uterine surgery were randomly divided into pupillary monitoring group (Group P) and control group (Group C). In Group P, remifentanil dosage during general anesthesia was determined according to pupil dilation reflex; in Group C, it was adjusted according to hemodynamic changes. Intraoperative remifentanil consumption and endotracheal tube extraction time were recorded. The Numerical Rating Scale (NRS) Score, hemodynamic changes, and opioid-related adverse reactions in the post-anesthesia care unit were also recorded. The parameters of pupil light reflex from extubation to 30 min after extubation were analyzed in Group P, and the responsiveness of these parameters and hemodynamic changes to NRS was determined by ROC curve analyses. RESULTS Compared with Group C, in Group P, intraoperative remifentanil consumption, the NRS Score at 20 minutes after extubation, extubation time, and the incidence of nausea, vomiting, and respiratory amnesia were all significantly decreased (all, P<0.05). In Group P, ∆HR and ∆MAP had no value in judging the change of NRS. The ROC values and diagnostic cutoff values of ΔInit, ΔACV, and ΔMCV responding to NRS variation were 0.775 (95% CI: 0.582-0.968), 0.734(95% CI: 0.537-0.930), and 0.822 (95% CI: 0.648-0.997) and 0.21 (sensitivity, 92.3%; specificity, 23.1%), -1.3 (sensitivity, 92.3%; specificity, 18.3%), and -1.0 (sensitivity, 84.6%; specificity, 17.7%), respectively. CONCLUSIONS Intraoperative pupil dilation reflex monitoring can reduce remifentanil consumption and improve postoperative recovery quality. Furthermore, postoperative pupil light reflex monitoring can help evaluate pain degree with high sensitivity.
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Affiliation(s)
- Leyang Yu
- Department of Anesthesiology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
- Dalian Medical University, Dalian, China
| | - Yang Yang
- Department of Anesthesiology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Hao Wu
- Department of Anesthesiology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Yanlong Yu
- Department of Anesthesiology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Ying Wang
- Department of Anesthesiology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
- Dalian Medical University, Dalian, China
| | - Shiting Yan
- Department of Anesthesiology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
- Dalian Medical University, Dalian, China
| | - Ning Li
- Department of Anesthesiology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Hu Li
- Department of Anesthesiology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
- Dalian Medical University, Dalian, China
| | - Chao Chen
- Department of Anesthesiology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Zhuan Zhang
- Department of Anesthesiology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China -
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Bardol M, Pan S, Walker SM, Standing JF, Dawes JM. Pharmacokinetic pharmacodynamic modeling of analgesics and sedatives in children. Paediatr Anaesth 2023; 33:781-792. [PMID: 37341161 PMCID: PMC10947261 DOI: 10.1111/pan.14712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/18/2023] [Accepted: 05/21/2023] [Indexed: 06/22/2023]
Abstract
Pharmacokinetic pharmacodynamic modeling is an important tool which uses statistical methodology to provide a better understanding of the relationship between concentration and effect of drugs such as analgesics and sedatives. Pharmacokinetic pharmacodynamic models also describe between-subject variability that allows identification of subgroups and dose adjustment for optimal pain management in individual patients. This approach is particularly useful in the pediatric population, where most drugs have received limited evaluation and dosing is extrapolated from adult practice. In children, the covariates of weight and age are used to describe size- and maturation-related changes in pharmacokinetics. It is important to consider both size and maturation in order to develop an accurate model and determine the optimal dose for different age groups. An adequate assessment of analgesic and sedative effect using pain scales or brain activity measures is essential to build reliable pharmacokinetic pharmacodynamic models. This is often challenging in children due to the multidimensional nature of pain and the limited sensitivity and specificity of some measurement tools. This review provides a summary of the pharmacokinetic and pharmacodynamic methodology used to describe the dose-concentration-effect relationship of analgesics and sedation in children, with a focus on the different pharmacodynamic endpoints and the challenges of pharmacodynamic modeling.
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Affiliation(s)
- Maddlie Bardol
- Infection, Immunity and Inflammation, Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Shan Pan
- Infection, Immunity and Inflammation, Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Suellen M. Walker
- Department of Anaesthesia and Pain MedicineGreat Ormond St Hospital NHS Foundation TrustLondonUK
- Developmental Neurosciences Program, UCL Great Ormond St Institute of Child HealthUniversity College LondonLondonUK
| | - Joseph F. Standing
- Infection, Immunity and Inflammation, Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
- Department of PharmacyGreat Ormond St Hospital NHS Foundation TrustLondonUK
| | - Joy M. Dawes
- Infection, Immunity and Inflammation, Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
- Department of Anaesthesia and Pain MedicineGreat Ormond St Hospital NHS Foundation TrustLondonUK
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Tognoli E, Luigi M. Using the TI.VA algorithm to titrate the depth of general anaesthesia: a first-in-humans study. BJA OPEN 2023; 7:100203. [PMID: 37638086 PMCID: PMC10457467 DOI: 10.1016/j.bjao.2023.100203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/26/2023] [Indexed: 08/29/2023]
Abstract
Background The dose of anaesthetic and opioid drugs must be continuously adjusted after the induction of general anaesthesia to maintain an adequate depth of anaesthesia. The TI.VA algorithm is a multiple-input/multiple-output algorithm designed to optimise the balance between anaesthetic and opioid concentrations during general anaesthesia. It applies vector analysis to a two-dimensional matrix to quantify any inadequacy of the depth of anaesthesia at any given moment and determine any drug dose adjustments required to achieve an adequate depth of anaesthesia. This study aimed to capture preliminary data on the performance and safety of the TI.VA algorithm during total i.v. anaesthesia in patients. Methods This prospective study enrolled nine patients with breast cancer scheduled to undergo surgery. General anaesthesia was induced under manual control using propofol and remifentanil. Anaesthesia was guided using the TI.VA algorithm from skin incision until surgical resection was completed. The quality of anaesthesia was assessed through an analysis of performance errors. A bispectral index global score (GSBIS) <50 was considered an acceptable target for algorithm performance. Results All nine procedures were completed without any adverse events and none of the patients recalled any intraoperative event. Overall, we analysed 3417 monitoring points corresponding to 285 min of surgery. All patients presented a GSBIS below the cut-off value of 50. Conclusions The TI.VA algorithm provides adequate control of clinical anaesthesia. A more sophisticated prototype needs to be developed before the trial is expanded to include larger patient populations. Clinical trial registration NCT05199883.
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Affiliation(s)
- Emiliano Tognoli
- Department of Anaesthesiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Mariani Luigi
- Unit of Clinical Epidemiology and Trial Organisation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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Chen X, Zhu Y, Peng K, Wang Q, Feng C. Effect of S-ketamine on the intraoperative Surgical Pleth Index in patients undergoing video-assisted thoracoscopic surgery: a single-center randomized controlled clinical trial. J Int Med Res 2023; 51:3000605231198386. [PMID: 37694976 PMCID: PMC10498711 DOI: 10.1177/03000605231198386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/14/2023] [Indexed: 09/12/2023] Open
Abstract
OBJECTIVE To investigate whether S-ketamine affects the Surgical Pleth Index (SPI) during video-assisted thoracoscopic surgery. METHODS Eighty-four patients undergoing video-assisted thoracoscopic lung lobectomy were enrolled. They were randomly assigned to an S-ketamine group (group S) and an equivalent normal saline group (group N). SPI values were recorded; and pain score on a numerical rating scale (NRS), the consumption of opioids, rescue analgesia, and post-operative nausea and vomiting (PONV) were evaluated. RESULTS The SPI and heart rate of the S-ketamine group were significantly lower 30 minutes after the start of surgery and at the end. The NRS score was lower in the S-ketamine group 6 and 12 hours postoperatively, but there were no differences in mean blood pressure or the NRS score 24 and 48 hours postoperatively. Rescue analgesia was required less frequently by the S-ketamine group, but the incidence of PONV did not differ between the groups. CONCLUSIONS S-ketamine was associated with lower intraoperative SPI 30 minutes after the start and at the end of surgery. It also reduced opioid use intraoperatively and the NRS scores 6 and 12 hours postoperatively.Trial registration: Chinese Clinical Trial Registry (ChiCTR2000040012), 18/11/2020.
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Affiliation(s)
- Xian Chen
- Department of Anesthesia, The First Affiliated Hospital of Soochow University, Suzhou, Jiang Su, China
| | - Yumin Zhu
- Department of Anesthesia, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Ke Peng
- Department of Anesthesia, The First Affiliated Hospital of Soochow University, Suzhou, Jiang Su, China
| | - Qinyun Wang
- Department of Anesthesia, The First Affiliated Hospital of Soochow University, Suzhou, Jiang Su, China
| | - Changdong Feng
- Department of Anesthesia, The First Affiliated Hospital of Soochow University, Suzhou, Jiang Su, China
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Kim SH, Chang CH, Lee JR, Seo SK, Kwon YI, Lee JH. Effect of analgesia nociception index monitor-based nociception control on perioperative stress responses during laparoscopic surgery in Trendelenburg position: a randomized controlled trial. Front Med (Lausanne) 2023; 10:1196153. [PMID: 37601786 PMCID: PMC10436464 DOI: 10.3389/fmed.2023.1196153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction The analgesia nociception index (ANI) monitor is a nociception monitoring device based on heart rate variability. We aimed to determine the effect of ANI monitor-based intraoperative nociception control on the perioperative stress response during laparoscopic surgery in the Trendelenburg position. Methods Altogether, 72 female patients who underwent total laparoscopic hysterectomy were randomized to either the control or ANI group. Intraoperative nociception was controlled by remifentanil administration in a conventional manner (based on blood pressure and heart rate) in the control group and by ANI monitoring in the ANI group. Perioperative stress responses were estimated by measuring the levels of serum catecholamines and catabolic stress hormones at three timepoints: after loss of consciousness, at the end of surgery, and 1 h after the end of surgery. Results The serum cortisol level at the end of surgery was significantly higher in the ANI group than in the control group (p < 0.001), although more remifentanil was administered in the ANI group than in the control group (p < 0.001). Changes in the other estimators' levels were comparable between groups during the perioperative period. The hemodynamic profiles during surgery were also significantly different between the two groups. Phenylephrine use to treat hypotension was more common in the ANI group than in the control group (p = 0.005). However, postoperative clinical outcomes such as pain and nausea/vomiting did not differ between groups. Conclusion ANI monitor-based nociception control in laparoscopic surgery in the Trendelenburg position did not improve perioperative stress responses, intraoperative opioid consumption, or postoperative clinical outcomes.Clinical trial registration: ClinicalTrials.gov (NCT04343638).
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Affiliation(s)
- Seung Hyun Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chul Ho Chang
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Rim Lee
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seok Kyo Seo
- Department of Obstetrics and Gynecology, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young In Kwon
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae Hoon Lee
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
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Yoon HK, Kim YJ, Lee HS, Seo JH, Kim HS. A randomised controlled trial of the analgesia nociception index for intra-operative remifentanil dose and pain after gynaecological laparotomy. Anaesthesia 2023; 78:988-994. [PMID: 36960477 DOI: 10.1111/anae.16008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2023] [Indexed: 03/25/2023]
Abstract
We aimed to investigate the effect of the analgesia nociception index on postoperative pain. We randomly allocated 170 women scheduled for gynaecological laparotomy and analysed results from 159: in 80 women, remifentanil was infused to maintain analgesia nociception indices 50-70; and in 79 women, remifentanil was infused to maintain systolic blood pressure < 120% of baseline values. The primary outcome was the proportion of women with pain scores ≥ 5 (scale 0-10) within 40 min of admission to recovery. The proportion of women with pain scores ≥ 5 was 62/80 (78%) vs. 64/79 (81%), p = 0.73. Mean (SD) doses of fentanyl in recovery were 53.6 (26.9) μg vs. 54.8 (20.8) μg, p = 0.74. Intra-operative remifentanil doses were 0.124 (0.050) μg.kg-1 .min-1 vs. 0.129 (0.044) μg.kg-1 .min-1 , p = 0.55.
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Affiliation(s)
- H-K Yoon
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Y J Kim
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - H S Lee
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - J-H Seo
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - H-S Kim
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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Jiang Y, Ding JM, Hao XX, Fang PP, Liu XS. EEG-derived pain threshold index-guided versus standard care during propofol-remifentanil anesthesia: A randomized controlled trial. Heliyon 2023; 9:e18604. [PMID: 37593599 PMCID: PMC10427989 DOI: 10.1016/j.heliyon.2023.e18604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/11/2023] [Accepted: 07/18/2023] [Indexed: 08/19/2023] Open
Abstract
Purpose The pain threshold index (PTI), a novel index of nociception based on spontaneous EEG wavelet analysis, has been reported to provide reliable accuracy for predicting postoperative pain and hemodynamic reactivity. The present study is aimed to investigate whether PTI-guided analgesia reduces the pain intensity and rate of remedial analgesia in the post-anesthesia care unit (PACU). Methods A total of 122 females undergoing elective gynecologic surgeries had been randomized to receive either PTI-guided analgesia (PTI group) or standard clinical care (control group). Remifentanil administration in the PTI group was guided by PTI to maintain the value between 40 and 65, while that in the control group was guided by hemodynamic changes. The primary outcome was remedial analgesia rate in the PACU. The postoperative pain scores, intraoperative remifentanil requirements, opioid-related adverse events and perioperative serum stress hormone concentrations between the two groups were also compared. Findings It was found that 23 of 58 patients (40%) in the control group and 8 of 58 patients (14%) in the PTI group needed remedial analgesia. The relative risk of receiving remedial analgesia was 2.88 (95% CI, 1.40-5.89, P = 0.002) in the control group. Sufentanil consumption in the PACU (μg) was lower in the PTI group (P = 0.002) than in the control group. Remifentanil and propofol consumption, opioid-related adverse events between these two groups were comparable. Implications PTI-guided analgesia during gynaecologic operations resulted in 25.87% less remedial analgesia. However, studies with different PTI thresholds and larger, more diverse populations should be conducted to further demonstrate the clinical effectiveness of PTI.
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Affiliation(s)
- Yu Jiang
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, PR China
| | - Jian-ming Ding
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, PR China
| | - Xi-xi Hao
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, PR China
| | - Pan-pan Fang
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, PR China
| | - Xue-Sheng Liu
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, PR China
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Nakanishi T, Fujiwara K, Sobue K. Prediction model of postoperative pain exacerbation using an intravenous patient-controlled analgesia device and a wearable electrocardiogram sensor. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38083793 DOI: 10.1109/embc40787.2023.10341072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
There is a need to develop objective and real-time postoperative pain assessment methods in perioperative medicine. Few studies have evaluated the relationship between pain severity and temporal changes of physiological signals in actual postoperative patients. In this study, we developed a machine learning model which was trained from intravenous patient-controlled analgesia (IV-PCA) records and electrocardiogram (ECG) of postoperative patients to predict pain exacerbation. A self-attentive autoencoder (SA-AE) model achieved 54% of sensitivity and a 1.76 times/h of false positive rate.Clinical relevance- We proposed a novel method for evaluating postoperative pain in real time and demonstrated the possibility of predicting pain exacerbation. The proposed method would realize the automatic administration of analgesics and the optimization of opioid doses.
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Zhou F, Cui Y, Cao L. The effect of opioid-free anaesthesia on the quality of recovery after endoscopic sinus surgery: A multicentre randomised controlled trial. Eur J Anaesthesiol 2023; Publish Ahead of Print:00003643-990000000-00107. [PMID: 37377372 DOI: 10.1097/eja.0000000000001784] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
BACKGROUND It remains to be determined whether opioid-free anaesthesia (OFA) is consistently effective for different types of surgery. OBJECTIVES The current study hypothesised that OFA could effectively inhibit intraoperative nociceptive responses, reduce side effects associated with opioid use, and improve the quality of recovery (QoR) in endoscopic sinus surgery (ESS). DESIGN A multicentre randomised controlled study. SETTING Seven hospitals participated in this multicentre trial from May 2021 to December 2021. PATIENTS Of the 978 screened patients who were scheduled for elective ESS, 800 patients underwent randomisation, and 773 patients were included in the analysis; 388 patients in the OFA group and 385 patients in the opioid anaesthesia group. INTERVENTIONS The OFA group received balanced anaesthesia with dexmedetomidine, lidocaine, propofol and sevoflurane; the opioid anaesthesia group received opioid-based balanced anaesthesia using sufentanil, remifentanil, propofol and sevoflurane. OUTCOME MEASURES The primary outcome was 24-h postoperative QoR as evaluated by the Quality of Recovery-40 questionnaire. The key secondary outcomes were episodes of postoperative pain and postoperative nausea and vomiting (PONV). RESULTS A significant difference (P = 0.0014) in the total score of 24-h postoperative Quality of Recovery-40 was found between the OFA group, median [interquartile range], 191 [185 to 196] and the opioid anaesthesia group (194 [187 to 197]). There were significant differences between the opioid anaesthesia group and the OFA group in the numerical rating scale score for pain after surgery at 30 min (P = 0.0017), 1 h (P = 0.0052), 2 h (P = 0.0079) and 24 h (P = 0.0303). The difference in the area under the curve of pain scale scores between the OFA group (24.2 [3.0 to 47.5]) and the opioid anaesthesia group (11.5 [1.0 to 39.0]) was significant (P = 0.0042). PONV occurred in 58 of 385 patients (15.1%) in the opioid anaesthesia group compared with 27 of 388 patients (7.0%) in the OFA group, suggesting the incidence of PONV in the OFA group was significantly lower than in the opioid anaesthesia group (P = 0.0021). CONCLUSION OFA can provide good intraoperative analgesia and postoperative recovery quality as effectively as conventional opioid anaesthesia in patients undergoing ESS. OFA can be an alternative option in the pain management of ESS. TRIAL REGISTRATION The study was registered at the Chinese Clinical Trial Registry (ChiCTR2100046158; registry URL: http://www.chictr.org.cn/enIndex.aspx.).
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Affiliation(s)
- Fengzhi Zhou
- From the Department of Anesthesia, The Second Xiangya Hospital of Central South University, Changsha, Hunan (FZ, YC, LC), Department of Anesthesia, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang (FZ) and Department of Anesthesia, Guilin Hospital of the Second Xiangya Hospital, Central South University, Guilin, Guangxi, China (LC)
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Kunst AM, Wulf H, Stegemann B, Fiehn A. [Intraoperative guidance of anesthesia: Analgesie Nociception Index (ANI) vs. standard care for hysterectomy under anesthesia with sevoflurane : A randomized controlled simple blinded study on intraoperative opioid consumption, postoperative pain and patient satisfaction]. DIE ANAESTHESIOLOGIE 2023:10.1007/s00101-023-01288-y. [PMID: 37284858 DOI: 10.1007/s00101-023-01288-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 03/20/2023] [Accepted: 03/30/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND General anesthesia leads to different effects depending on the drugs used (hypnosis, analgesia, muscle relaxation). While there are validated methods for clinical monitoring and control of hypnosis and muscle relaxation in routine anesthesia, the assessment of analgesia is still mainly based on the interpretation of clinical vital parameters, such as heart rate, blood pressure, perspiration or intraoperative movements of the patient. The present clinical study investigated whether the use of a so-called nociception monitor to record the intraoperative need for analgesics is superior to the previous analysis of vital parameters. The analgesia nociception index (ANI; MDoloris, Lille, France) was used, which is one of several nociception monitors currently on the market for recording the sympathicovagal balance. In the case of the ANI, the measurement is based on the analysis of the heart rate variability (HRV) as a function of breathing. The index is given in the form of a dimensionless score between 0 and 100, where 0 stands for a lack of parasympathetic activity and 100 for a very strong parasympathetic activity. According to the manufacturer, a value between 50-70 under anesthesia corresponds to sufficient intraoperative analgesia. METHODS This was a clinical prospective randomized study in which 110 patients who underwent laparoscopic hysterectomy under balanced anesthesia using propofol, fentanyl and atracurium for induction and sevoflurane and fentanyl for anesthesia maintenance, were divided into two groups. In the intervention group (ANI group), during the operation analgesics were administered with the aid of the ANI monitor (bolus of 0.1 mg fentanyl if the ANI was < 50), whereas in the comparison group analgesics were administered according to previous clinical parameters (vital parameters, intraoperative defensive movements). The groups were then compared with respect to intraoperative fentanyl consumption (primary outcome), postoperative pain and opioid-induced side effects (measured by the numeric rating scale [NRS]) as well as patient satisfaction on postoperative day 3 (secondary outcome). RESULTS The observations showed a higher total intraoperative consumption of fentanyl in the intervention group, due to a significantly higher number of individual doses (0.54 vs. 0.44 mg, p < 0.001). With respect to the other observation points, there were hardly any differences between the groups, neither with respect to the pain score nor the side effects in the recovery room. At most there was a trend towards a slightly lower pain score at the first measurement point in the recovery room (NRS at 15 min). In the patient survey on the postoperative day 3, there was a difference with respect to the subjectively described reduction in vigilance in the ANI group, but not other side effects or overall satisfaction with the pain therapy. CONCLUSION In this group of patients the additional use of the ANI monitor for intraoperative control of analgesia led to an increased consumption of fentanyl compared to the comparison group, without having an impact on the postoperative pain score, opioid-induced side effects or patient satisfaction. An optimization of pain therapy through intraoperative use of the ANI monitoring in hysterectomy patients under balanced anesthesia with sevoflurane and fentanyl could therefore not be proven. Transferability of the results to a much older and/or sicker patient collective remains questionable.
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Affiliation(s)
- A M Kunst
- Klinik für Anästhesie und Intensivmedizin, Uniklinik der Philipps-Universität Marburg, Marburg, Deutschland.
- Klinik für Anästhesiologie und Intensivmedizin, Agaplesion Diakonie Kliniken Kassel, Kassel, Deutschland.
- , Herkulesstraße 34, 34119, Kassel, Deutschland.
| | - H Wulf
- Klinik für Anästhesie und Intensivmedizin, Uniklinik der Philipps-Universität Marburg, Marburg, Deutschland
| | - B Stegemann
- Zentrum für klinische Forschung Kassel, Kassel, Deutschland
| | - A Fiehn
- Klinik für Anästhesiologie und Intensivmedizin, Agaplesion Diakonie Kliniken Kassel, Kassel, Deutschland
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Deverett B. Anesthesia for non-traditional consciousness. Front Hum Neurosci 2023; 17:1146242. [PMID: 37228852 PMCID: PMC10203240 DOI: 10.3389/fnhum.2023.1146242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/17/2023] [Indexed: 05/27/2023] Open
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Kang J, Fang C, Li Y, Yuan Y, Niu K, Zheng Y, Yu Y, Wang G, Li Y. Effects of qCON and qNOX-guided general anaesthesia management on patient opioid use and prognosis: a study protocol. BMJ Open 2023; 13:e069134. [PMID: 37130687 PMCID: PMC10163456 DOI: 10.1136/bmjopen-2022-069134] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
INTRODUCTION The adverse effects of general anaesthetic drugs (especially opioids) cannot be ignored. However, current nociceptive-monitoring techniques still lack consistency in guiding the use of opioids. This trial will study the demand for opioid use and patient prognosis in qCON and qNOX-guided general anaesthesia management. METHODS AND ANALYSIS This prospective, randomised, controlled trial will randomly recruit 124 patients undergoing general anaesthesia for non-cardiac surgery in equal numbers to either the qCON or BIS group. The qCON group will adjust intraoperative propofol and remifentanil dosage according to qCON and qNOX values, while the BIS group will adjust according to BIS values and haemodynamic fluctuations. The differences between the two groups will be observed in remifentanil dosing and prognosis. The primary outcome will be intraoperative remifentanil use. Secondary outcomes will include propofol consumption; the predictive ability of BIS, qCON and qNOX on conscious responses, noxious stimulus and body movements; and changes in cognitive function at 90 days postoperatively. ETHICS AND DISSEMINATION This study involves human participants and was approved by the Ethics Committee of the Tianjin Medical University General Hospital (IRB2022-YX-075-01). Participants gave informed consent to participate in the study before taking part. The study results will be published in peer-reviewed journals and presented at relevant academic conferences. TRIAL REGISTRATION NUMBER ChiCTR2200059877.
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Affiliation(s)
- Jiamin Kang
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Research Institute of Anesthesiology, Tianjin, China
| | - Chongliang Fang
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Research Institute of Anesthesiology, Tianjin, China
| | - Yuanjie Li
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Research Institute of Anesthesiology, Tianjin, China
| | - Yuan Yuan
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Research Institute of Anesthesiology, Tianjin, China
| | - Kaijun Niu
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yuxin Zheng
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Research Institute of Anesthesiology, Tianjin, China
| | - Yonghao Yu
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Research Institute of Anesthesiology, Tianjin, China
| | - Guolin Wang
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Research Institute of Anesthesiology, Tianjin, China
| | - Yize Li
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Research Institute of Anesthesiology, Tianjin, China
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Sabourdin N, Degoul S, Lafanechere A, Jeanne M, Tavernier B. Effect of rapid changes in venous return on the Analgesia Nociception Index™ in anaesthetised patients. Br J Anaesth 2023:S0007-0912(23)00175-7. [PMID: 37142467 DOI: 10.1016/j.bja.2023.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 03/31/2023] [Indexed: 05/06/2023] Open
Affiliation(s)
- Nada Sabourdin
- Department of Anesthesiology, CHU Armand Trousseau, GRC 29, Sorbonne University, APHP, Paris, France; University of Paris EA 7323: Pharmacologie et évaluation des Thérapeutiques chez L'enfant et la Femme Enceinte, Paris, France
| | - Samuel Degoul
- CHU Lille, Pôle d'anesthésie-réanimation, Lille, France
| | | | - Mathieu Jeanne
- CHU Lille, Pôle d'anesthésie-réanimation, Lille, France; University of Lille, ULR 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France; Inserm, CIC 1403 - Centre d'investigation clinique, Lille, France
| | - Benoit Tavernier
- CHU Lille, Pôle d'anesthésie-réanimation, Lille, France; University of Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de santé et des Pratiques médicales, Lille, France.
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Ghita M, Birs IR, Copot D, Muresan CI, Ionescu CM. Bioelectrical impedance analysis of thermal-induced cutaneous nociception. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2023.104678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Koschmieder KC, Funcke S, Shadloo M, Pinnschmidt HO, Greiwe G, Fischer M, Nitzschke R. Validation of three nociception indices to predict immediate postoperative pain before emergence from general anaesthesia: a prospective double-blind, observational study. Br J Anaesth 2023; 130:477-484. [PMID: 36609057 DOI: 10.1016/j.bja.2022.11.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/25/2022] [Accepted: 11/09/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Nociception monitoring devices are designed to estimate nociception during general anaesthesia. We evaluated the predictive accuracy of heart rate and three nociception indices to predict postoperative pain before emergence from general anaesthesia. METHODS In patients undergoing trauma or orthopaedic surgery, HR, Surgical Pleth Index® (SPI), Pupillary Pain Index® (PPI), and Nociception Level® (NOL) were simultaneously recorded for 5 min after the end of surgery but before return of consciousness. After admission to the recovery room, pain scores were assessed regularly for 2 h. HR, SPI, PPI, and NOL were analysed for their predictive accuracy of postoperative pain and opioid consumption with assessment of area under the receiver operating characteristic (AUC) curves, Spearman rank-correlation coefficient, and regression modelling. RESULTS Data for 60 subjects were analysed. The AUC (95% confidence interval [95% CI]) of the predictive accuracy for moderate-to-severe postoperative pain differed between nociception indices (HR=0.46 [0.29-0.64], P=0.671; SPI=0.46 [0.31-0.61], P=0.621; PPI=0.52 [0.36-0.68], P=0.770; NOL=0.66 [0.51-0.81], P=0.038). In a multivariable logistic regression model, a higher predictive accuracy was found for a multivariable predictor combining NOL values with ASA physical status and information about use of regional anaesthesia (AUC=0.83 [0.72-0.94], P<0.001). CONCLUSIONS Heart rate, Surgical Pleth Index, Pupillary Pain Index, and Nociception Level measured before emergence from general anaesthesia do not yet have sufficient diagnostic accuracy for prediction of postoperative pain. CLINICAL TRIAL REGISTRATION NCT05063227.
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Affiliation(s)
- Kim C Koschmieder
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sandra Funcke
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mahshid Shadloo
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans O Pinnschmidt
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gillis Greiwe
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marlene Fischer
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rainer Nitzschke
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Ruetzler K, Montalvo M, Bakal O, Essber H, Rössler J, Mascha EJ, Han Y, Ramachandran M, Keebler A, Turan A, Sessler DI. Nociception Level Index-Guided Intraoperative Analgesia for Improved Postoperative Recovery: A Randomized Trial. Anesth Analg 2023; 136:761-771. [PMID: 36727855 DOI: 10.1213/ane.0000000000006351] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Nociception is the physiological response to nociceptive stimuli, normally experienced as pain. During general anesthesia, patients experience and respond to nociceptive stimuli by increasing blood pressure and heart rate if not controlled by preemptive analgesia. The PMD-200 system from Medasense (Ramat Gan, Israel) evaluates the balance between nociceptive stimuli and analgesia during general anesthesia and generates the nociception level (NOL) index from a single finger probe. NOL is a unitless index ranging from 0 to 100, with values exceeding 25 indicating that nociception exceeds analgesia. We aimed to demonstrate that titrating intraoperative opioid administration to keep NOL <25 optimizes intraoperative opioid dosing. Specifically, we tested the hypothesis that pain scores during the initial 60 minutes of recovery are lower in patients managed with NOL-guided fentanyl than in patients given fentanyl per clinical routine. METHODS We conducted a randomized, single-center trial of patients having major abdominal open and laparoscopic surgeries. Patients were randomly assigned 1:1 to intraoperative NOL-guided fentanyl administration or fentanyl given per clinical routine. The primary outcome was pain score (0-10 verbal response scale) at 10-minute intervals during the initial 60 minutes of recovery. Our secondary outcome was a measure of adequate analgesia, defined as a pain score <5, assessed separately at each interval. RESULTS With a planned maximum sample size of 144, the study was stopped for futility after enrolling 72 patients from November 2020 to October 2021. Thirty-five patients were assigned to NOL-guided analgesic dosing and 37 to routine care. Patients in the NOL group spent significantly less time with a NOL index >25 (median reduction [95% confidence interval {CI}] of 14 [4-25] minutes) were given nearly twice as much intraoperative fentanyl (median [quartiles] 500 [330, 780] vs 300 [200, 330] µg), and required about half as much morphine in the recovery period (3.3 [0, 8] vs 7.7 [0, 13] mg). However, in the primary outcome analysis, NOL did not reduce pain scores in the first 60 minutes after awakening, assessed in a linear mixed effects model with mean (standard error [SE]) of 4.12 (0.59) for NOL and 4.04 (0.58) for routine care, and estimated difference in means of 0.08 (-1.43, 1.58), P = .895. CONCLUSIONS More intraoperative fentanyl was given in NOL-guided patients, but NOL guidance did not reduce initial postoperative pain scores.
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Affiliation(s)
- Kurt Ruetzler
- From the Departments of Outcomes Research
- General Anesthesiology
| | | | - Omer Bakal
- From the Departments of Outcomes Research
| | | | | | - Edward J Mascha
- From the Departments of Outcomes Research
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Yanyan Han
- From the Departments of Outcomes Research
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | | | | | - Alparslan Turan
- From the Departments of Outcomes Research
- General Anesthesiology
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Goff J, Hina M, Malik N, McLardy H, Reilly F, Robertson M, Ruddy L, Willox F, Forget P. Can Opioid-Free Anaesthesia Be Personalised? A Narrative Review. J Pers Med 2023; 13:jpm13030500. [PMID: 36983682 PMCID: PMC10056629 DOI: 10.3390/jpm13030500] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/04/2023] [Accepted: 03/08/2023] [Indexed: 03/12/2023] Open
Abstract
Background: A significant amount of evidence suggests that Opioid-Free Anaesthesia (OFA) may provide better outcomes for patients undergoing surgery, sparing patients who are particularly vulnerable to adverse side effects of opioids. However, to what extent personalizing OFA is feasible and beneficial has not been adequately described. Methods: We conducted a narrative literature review aiming to provide a comprehensive understanding of nociception and pain and its context within the field of OFA. Physiological (including monitoring), pharmacological, procedural (type of surgery), genetical and phenotypical (including patients’ conditions) were considered. Results: We did not find any monitoring robustly associated with improved outcomes. However, we found evidence supporting particular OFA indications, such as bariatric and cancer surgery. We found that vulnerable patients may benefit more from OFA, with an interesting field of research in patients suffering from vascular disease. We found a variety of techniques and medications making it impossible to consider OFA as a single technique. Our findings suggest that a vast field of research remains unexplored. In particular, a deeper understanding of nociception with an interest in its genetic and acquired contributors would be an excellent starting point paving the way for personalised OFA. Conclusion: Recent developments in OFA may present a more holistic approach, challenging the use of opioids. Understanding better nociception, given the variety of OFA techniques, may help to maximize their potential in different contexts and potential indications.
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Affiliation(s)
- Jenna Goff
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen AB25 2ZD, UK
| | - Morgan Hina
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen AB25 2ZD, UK
| | - Nayaab Malik
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen AB25 2ZD, UK
| | - Hannah McLardy
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen AB25 2ZD, UK
| | - Finley Reilly
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen AB25 2ZD, UK
| | - Matthew Robertson
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen AB25 2ZD, UK
- Correspondence:
| | - Louis Ruddy
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen AB25 2ZD, UK
| | - Faith Willox
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen AB25 2ZD, UK
| | - Patrice Forget
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen AB25 2ZD, UK
- Department of Anaesthesia, NHS Grampian, Aberdeen AB25 2ZD, UK
- Pain AND Opioids after Surgery (PANDOS) European Society of Anaesthesia and Intensive Care (ESAIC) Research Group, 1000 Brussels, Belgium
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Mondardini MC, Sperotto F, Daverio M, Amigoni A. Analgesia and sedation in critically ill pediatric patients: an update from the recent guidelines and point of view. Eur J Pediatr 2023; 182:2013-2026. [PMID: 36892607 DOI: 10.1007/s00431-023-04905-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/14/2023] [Accepted: 02/26/2023] [Indexed: 03/10/2023]
Abstract
In the last decades, the advancement of knowledge in analgesia and sedation for critically ill pediatric patients has been conspicuous and relevant. Many recommendations have changed to ensure patients' comfort during their intensive care unit (ICU) stay and prevent and treat sedation-related complications, as well as improve functional recovery and clinical outcomes. The key aspects of the analgosedation management in pediatrics have been recently reviewed in two consensus-based documents. However, there remains a lot to be researched and understood. With this narrative review and authors' point of view, we aimed to summarize the new insights presented in these two documents to facilitate their interpretation and application in clinical practice, as well as to outline research priorities in the field. Conclusion: With this narrative review and authors' point of view, we aimed to summarize the new insights presented in these two documents to facilitate their interpretation and application in clinical practice, as well as to outline research priorities in the field. What is Known: • Critically ill pediatric patients receiving intensive care required analgesia and sedation to attenuate painful and stressful stimuli. •Optimal management of analgosedation is a challenge often burdened with complications such as tolerance, iatrogenic withdrawal syndrome, delirium, and possible adverse outcomes. What is New: •The new insights on the analgosedation treatment for critically ill pediatric patients delineated in the recent guidelines are summarized to identify strategies for changes in clinical practice. •Research gaps and potential for quality improvement projects are also highlighted.
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Affiliation(s)
- Maria Cristina Mondardini
- Pediatric Anesthesia and Intensive Care Unit, Department of Woman's and Child's Health, IRCCS University Hospital of Bologna Policlinico S. Orsola, Bologna, Italy
| | - Francesca Sperotto
- Cardiovascular Critical Care Unit, Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Marco Daverio
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Angela Amigoni
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy.
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Real-time evaluation of the independent analgesic efficacy of dexmedetomidine. BMC Anesthesiol 2023; 23:68. [PMID: 36870944 PMCID: PMC9985296 DOI: 10.1186/s12871-023-02022-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 02/16/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Dexmedetomidine has analgesic properties, but the intraoperative analgesic effect of dexmedetomidine is often masked by the effects of other general anaesthetics. Therefore, the degree to which it reduces intraoperative pain intensity remains unclear. The objective of this double-blind, randomised controlled trial was to evaluate the independent intraoperative analgesic efficacy of dexmedetomidine in real-time. METHODS This single-centre study enrolled 181 patients who were hospitalised for below-knee orthopaedic surgeries between 19 January 2021 to 3 August 2021 were eligible for this is single-centre study. Peripheral neural block was performed on patients scheduled for below-knee orthopaedic surgeries. Patients were randomly assigned to the dexmedetomidine or midazolam group and were intravenously administered with 1.5 µg kg-1 h-1 dexmedetomidine or 50 µg kg-1 h-1 midazolam, respectively. The analgesic efficacy was evaluated using the real-time non-invasive nociception monitoring. The primary endpoint was the attainment rate of the nociception index target. The secondary endpoints included the occurrence of intraoperative hypoxemia, haemodynamic parameters, the consciousness index, electromyography and patient outcomes. RESULTS On Kaplan-Meier survival analysis, the defined nociception index target was attained in 95.45% and 40.91% of patients receiving dexmedetomidine and midazolam, respectively. Log-rank analysis revealed that the dexmedetomidine group attained the nociception index target significantly faster and the median attainment time of the nociception index target in the dexmedetomidine group was 15 min. Dexmedetomidine group was associated with a significantly lower incidence of hypoxemia. There was no significant difference in blood pressure between the dexmedetomidine and midazolam groups. Further, the dexmedetomidine group had a lower maximum visual analogue scale score and lower analgesic consumption postoperatively. CONCLUSIONS Dexmedetomidine has independent analgesia and systemically administered as an adjuvant agent has better analgesic efficacy than midazolam without severe side effects. TRIAL REGISTRATION clinicaltrial.gov Registry Identifier: NCT-04675372.Registered on 19/12 /2020.
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Anders M, Anders B, Dreismickenbecker E, Hight D, Kreuzer M, Walter C, Zinn S. EEG responses to standardised noxious stimulation during clinical anaesthesia: a pilot study. BJA OPEN 2023; 5:100118. [PMID: 37587999 PMCID: PMC10430841 DOI: 10.1016/j.bjao.2022.100118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/05/2022] [Indexed: 08/18/2023]
Abstract
Background During clinical anaesthesia, the administration of analgesics mostly relies on empirical knowledge and observation of the patient's reactions to noxious stimuli. Previous studies in healthy volunteers under controlled conditions revealed EEG activity in response to standardised nociceptive stimuli even at high doses of remifentanil and propofol. This pilot study aims to investigate the feasibility of using these standardised nociceptive stimuli in routine clinical practice. Methods We studied 17 patients undergoing orthopaedic trauma surgery under general anaesthesia. We evaluated if the EEG could track standardised noxious phase-locked electrical stimulation and tetanic stimulation, a time-locked surrogate for incisional pain, before, during, and after the induction of general anaesthesia. Subsequently, we analysed the effect of tetanic stimulation on the surgical pleth index as a peripheral, vegetative, nociceptive marker. Results We found that the phase-locked evoked potentials after noxious electrical stimulation vanished after the administration of propofol, but not at low concentrations of remifentanil. After noxious tetanic stimulation under general anaesthesia, there were no consistent spectral changes in the EEG, but the vegetative response in the surgical pleth index was statistically significant (Hedges' g effect size 0.32 [95% confidence interval 0.12-0.77], P=0.035). Conclusion Our standardised nociceptive stimuli are not optimised for obtaining consistent EEG responses in patients during clinical anaesthesia. To validate and sufficiently reproduce EEG-based standardised stimulation as a marker for nociception in clinical anaesthesia, other pain models or stimulation settings might be required to transfer preclinical studies into clinical practice. Clinical trial registration DRKS00017829.
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Affiliation(s)
- Malte Anders
- Clinical Development and Human Pain Models, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Frankfurt, Germany
| | - Björn Anders
- Clinical Development and Human Pain Models, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Frankfurt, Germany
| | - Elias Dreismickenbecker
- Clinical Development and Human Pain Models, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Frankfurt, Germany
- Center for Pediatric and Adolescent Medicine, Childhood Cancer Center, University Medical Center Mainz, Mainz, Germany
| | - Darren Hight
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matthias Kreuzer
- Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, Munich, Germany
| | - Carmen Walter
- Clinical Development and Human Pain Models, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Frankfurt, Germany
| | - Sebastian Zinn
- Clinical Development and Human Pain Models, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Frankfurt, Germany
- Goethe University Frankfurt, University Hospital, Clinic for Anesthesiology, Intensive Care Medicine and Pain Therapy, Frankfurt am Main, Germany
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