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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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2
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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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3
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Ruíz-López P, Domínguez JM, Morgaz J, Quirós-Carmona S, Navarrete-Calvo R, Gómez-Villamandos RJ, Fernández-Sarmiento JA, Granados MM. Evaluation of the Averaged Parasympathetic Tone Activity and Its Dynamic Variation to Assess Intraoperative Nociception in Relation to Hemodynamic Changes in Dogs. Vet Q 2023:1-19. [PMID: 37467574 PMCID: PMC10367571 DOI: 10.1080/01652176.2023.2239311] [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: 12/08/2022] [Revised: 05/15/2023] [Accepted: 07/15/2023] [Indexed: 07/21/2023] Open
Abstract
This study aimed to determine the performance of the averaged parasympathetic tone activity (PTAm) and its dynamic variation (ΔPTA) to assess intraoperative nociception in relation to heart rate (HR) and direct mean arterial pressure (MAP) in dogs undergoing laparoscopic ovariectomy. This prospective, observational, clinical study included 32 bitches. The PTAm, HR, MAP, and bispectral index (BIS) were assessed before (pre-stimulus), as well as 1 min and 2 min after, four surgical stimuli: insufflation, introduction of trocars, and removal of the left and right ovaries. A two-way ANOVA was performed to compare PTAm, HR, MAP, and BIS data across surgical stimuli. A ≥20% drop in PTAm or a ≥20% increase in HR and/or MAP regarding the pre-stimulus values was considered a PTAm-drop and/or a hemodynamic response, respectively. The performance of PTAm pre-stimulus, PTAm 1 min, and ΔPTA in predicting the hemodynamic response was assessed by calculation of the area under the receiver operating characteristic (ROC) curve. At insufflation, PTAm decreased after 1 (p = 0.010) and 2 (p = 0.045)min, and ΔPTA was different (p = 0.005) between dogs that presented hemodynamic response and dogs that did not. At PTAm-drop, MAP increased after 1 min (p = 0.001) and 2 min (p = 0.001) with respect to pre-stimulus value, whereas HR and BIS did not change. ROC curves showed a threshold value of PTAm pre-stimulus ≤51 to detect hemodynamic response (sensitivity 69%, specificity 52%). The PTAm and ΔPTA only assessed intraoperative nociception during insufflation. The PTAm pre-stimulus association to the hemodynamic response in anaesthetized dogs showed poor sensitivity and no specificity.
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Affiliation(s)
- Patricia Ruíz-López
- Department of Large Animal Surgery, Anaesthesia and Orthopedics, Faculty of Veterinary Medicine, University of Ghent, 9820 Merelbeke, Belgium
| | - Juan Manuel Domínguez
- Animal Medicine and Surgery Department, Faculty of Veterinary Medicine, University of Cordoba, 14014 Cordoba, Spain
| | - Juan Morgaz
- Animal Medicine and Surgery Department, Faculty of Veterinary Medicine, University of Cordoba, 14014 Cordoba, Spain
| | - Setefilla Quirós-Carmona
- Animal Medicine and Surgery Department, Faculty of Veterinary Medicine, University of Cordoba, 14014 Cordoba, Spain
| | - Rocío Navarrete-Calvo
- Animal Medicine and Surgery Department, Faculty of Veterinary Medicine, University of Cordoba, 14014 Cordoba, Spain
| | | | | | - M M Granados
- Animal Medicine and Surgery Department, Faculty of Veterinary Medicine, University of Cordoba, 14014 Cordoba, Spain
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Relationship between ANI and qNOX and between MAC and qCON during outpatient laparoscopic cholecystectomy using remifentanil and desflurane without muscle relaxants: a prospective observational preliminary study. J Clin Monit Comput 2023; 37:83-91. [PMID: 35445895 DOI: 10.1007/s10877-022-00861-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 03/31/2022] [Indexed: 01/24/2023]
Abstract
This study was designed to investigate qCON and qNOX variations during outpatient laparoscopic cholecystectomy using remifentanil and desflurane without muscle relaxants and compare these indices with ANI and MAC. Adult patients undergoing outpatient laparoscopic cholecystectomy were included in this prospective observational study. Maintenance of anesthesia was performed using remifentanil targeted to ANI 50-80 and desflurane targeted to MAC 0.8-1.2 without muscle relaxants. The ANI, qCON and qNOX and desflurane MAC values were collected at different time-points and analyzed using repeated measures ANOVA. The relationship between ANI and qNOX and between qCON and MAC were analyzed by linear regression. The ANI was comprised between 50 and 80 during maintenance of anesthesia. Higher values of qNOX and qCON were observed at induction and extubation than during all other time-points where they were comprised between 40 and 60. A poor but significant negative linear relationship (r2 = 0.07, p < 0.001) was observed between ANI and qNOX. There also was a negative linear relationship between qCON and MAC (r2 = 0.48, p < 0.001) and between qNOX and remifentanil infusion rate (r2 = 0.13, p < 0.001). The linear mixed-effect regression correlation (r2) was 0.65 for ANI-qNOX and 0.96 for qCON-MAC. The qCON and qNOX monitoring seems informative during general anesthesia using desflurane and remifentanil without muscle relaxants in patients undergoing ambulatory laparoscopic cholecystectomy. While qCON correlated with MAC, the correlation of overall qCON and ANI was poor but significant. Additionally, the qNOX weakly correlated with the remifentanil infusion rate. This observational study suggests that the proposed ranges of 40-60 for both indexes may correspond to adequate levels of hypnosis and analgesia during general anesthesia, although this should be confirmed by further research.
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Bonin EAC, Lejeune N, Szymkowicz E, Bonhomme V, Martial C, Gosseries O, Laureys S, Thibaut A. Assessment and management of pain/nociception in patients with disorders of consciousness or locked-in syndrome: A narrative review. Front Syst Neurosci 2023; 17:1112206. [PMID: 37021037 PMCID: PMC10067681 DOI: 10.3389/fnsys.2023.1112206] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/06/2023] [Indexed: 04/07/2023] Open
Abstract
The assessment and management of pain and nociception is very challenging in patients unable to communicate functionally such as patients with disorders of consciousness (DoC) or in locked-in syndrome (LIS). In a clinical setting, the detection of signs of pain and nociception by the medical staff is therefore essential for the wellbeing and management of these patients. However, there is still a lot unknown and a lack of clear guidelines regarding the assessment, management and treatment of pain and nociception in these populations. The purpose of this narrative review is to examine the current knowledge regarding this issue by covering different topics such as: the neurophysiology of pain and nociception (in healthy subjects and patients), the source and impact of nociception and pain in DoC and LIS and, finally, the assessment and treatment of pain and nociception in these populations. In this review we will also give possible research directions that could help to improve the management of this specific population of severely brain damaged patients.
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Affiliation(s)
- Estelle A. C. Bonin
- Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
- Centre du Cerveau, Liège University Hospital, Liège, Belgium
| | - Nicolas Lejeune
- Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
- Centre Hospitalier Neurologique (CHN) William Lennox, Saint-Luc Hospital Group, Ottignies-Louvain-la-Neuve, Belgium
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Emilie Szymkowicz
- Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
- Centre du Cerveau, Liège University Hospital, Liège, Belgium
| | - Vincent Bonhomme
- Department of Anesthesia and Intensive Care Medicine, Liège University Hospital, Liège, Belgium
- Anesthesia and Perioperative Neuroscience Laboratory, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
| | - Charlotte Martial
- Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
- Centre du Cerveau, Liège University Hospital, Liège, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
- Centre du Cerveau, Liège University Hospital, Liège, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
- Centre du Cerveau, Liège University Hospital, Liège, Belgium
- Joint International Research Unit on Consciousness, CERVO Brain Research Centre, Centre Intégré Universitaire de Santé et Services Sociaux (CIUSS), University Laval, Québec City, QC, Canada
| | - Aurore Thibaut
- Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
- Centre du Cerveau, Liège University Hospital, Liège, Belgium
- *Correspondence: Aurore Thibaut,
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Kim ED, Lee Y, Choi S, Lee H, Ohn C, Kwon W. Abdominal Wall Block Decreases Intraoperative Opioid Con-Sumption by Surgical Pleth Index-Guided Remifentanil Administration in Single-Port Laparoscopic Herniorrhaphy: A Prospective Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16012. [PMID: 36498087 PMCID: PMC9736213 DOI: 10.3390/ijerph192316012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/26/2022] [Accepted: 11/27/2022] [Indexed: 06/17/2023]
Abstract
Abdominal wall blocks (AWBs) can reduce pain during surgery and lessen opioid demand. Since it is difficult to know the exact level of intraoperative pain, it is not known how much the opioid dose should be reduced. In this study, using the surgical pleth index (SPI), which indicates pain index from sympathetic fibers, the amount of remifentanil consumption was investigated. We conducted single-port laparoscopic hernia repair in 64 patients, as follows: the regional block group (R group) was treated with AWB, while the control group (C group) was only subjected to general anesthesia. In both groups, the remifentanil concentration was adjusted to maintain the SPI score between 30 and 40 during surgery. The primary parameter was the amount of remifentanil. A total of 52 patients completed the study (24 in the R group, 28 in the C group). The remifentanil dose during surgery was decreased in the R group (29 ± 21 vs. 56 ± 36 ng/kg/min; p = 0.002). Visual analogue scale score and additional administrated analgesics were also low in the R group. As such, AWB can reduce the remifentanil dose while maintaining the same pain level.
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7
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Michalot A, Bazin JÉ, Richebé P, Allaouchiche B, Boselli E. Effect of GOAL-Directed ANalgesia using ANI (Analgesia/Nociception Index) during general anesthesia on immediate postoperative pain and intraoperative hemodynamics in adult patients (GOALDAN study): a study protocol for randomized, controlled, multicenter trial. Trials 2022; 23:353. [PMID: 35468803 PMCID: PMC9040325 DOI: 10.1186/s13063-022-06273-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 04/02/2022] [Indexed: 12/24/2022] Open
Abstract
Background Severe postoperative pain remains a major problem that is seen in 20 to 40% of patients. The Analgesia/Nociception Index (ANI) is a 0–100 index reflecting the relative parasympathetic activity allowing for intraoperative analgesia monitoring. We have previously shown that an ANI value < 50 immediately before extubation may predict the occurrence of immediate postoperative pain with good performance. We hypothesized that GOAL-Directed ANalgesia may provide reduced immediate postoperative pain and optimized intraoperative remifentanil administration (GOLDAN study). Methods The GOALDAN study is an international, multicenter, simple-blind, parallel, prospective, randomized, controlled, two-armed trial. Patients are randomly assigned in a 1:1 ratio in the control group or in the experimental group. Patients will be randomly allocated to either the intervention group (ANI) or the control group (standard care only). In the ANI group, the administration of remifentanil will be goal-directed targeting a 50–80 ANI range, with a prophylactic injection of morphine immediately after extubation if the case of ANI < 50. Our primary objective was to determine whether the prophylactic administration of morphine at the end of the procedure in patients at risk of immediate postoperative pain (ANI < 50 immediately before extubation) could reduce the incidence of the latter by 50% in the post-anesthetic care unit. Our secondary objective was to determine whether the intraoperative use of goal-directed analgesia with an ANI target of 50 to 80 could improve intraoperative hemodynamics and postoperative outcome. Discussion Because of the paucity of well-conducted trials, the authors believe that a randomized-controlled trial will improve the evidence for using analgesia monitoring during general anesthesia and strengthen current recommendations for intraoperative analgesia management. Trial registration ClinicalTrials.gov NCT03618082. Registered on 7 August 2018
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Affiliation(s)
- Adrien Michalot
- Department of Anesthesiology and Intensive Care, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Jean-Étienne Bazin
- Department of Anesthesiology and Intensive Care, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Philippe Richebé
- Department of Anesthesiology and Pain Medicine, Maisonneuve-Rosemont Hospital - CIUSSS de L'Est de l'Ile de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Bernard Allaouchiche
- APCSe VetAgro Sup UPSP 2016.A101, Claude Bernard Lyon 1 University, Université de Lyon, Marcy-l'Étoile, France
| | - Emmanuel Boselli
- APCSe VetAgro Sup UPSP 2016.A101, Claude Bernard Lyon 1 University, Université de Lyon, Marcy-l'Étoile, France. .,Groupement Hospitalier Nord Dauphiné, Pierre Oudot Hospital Centre, Department of Anesthesiology, Bourgoin-Jallieu, France.
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8
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Lv J, Zhang J, Zhang K, Zheng J. Predictive value of EEG-derived pain threshold index for acute postoperative pain in children. Front Pediatr 2022; 10:1052532. [PMID: 36619500 PMCID: PMC9811812 DOI: 10.3389/fped.2022.1052532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Electroencephalogram (EEG)-derived pain threshold index (PTI) has been developed as a novel pain recognition indicator and has been proved to be useful in the prediction of acute postoperative pain in adults. Evidence of its usability in children is limited. The aim of this study was to investigate the prediction value of this novel pain indicator PTI for acute postoperative pain in children. METHODS A total of 80 patients undergoing laparoscopic surgery under general anesthesia were enrolled. Blood pressure, heart rate (HR), surgical pleth index (SPI), PTI, and EEG-derived sedative index-wavelet index (WLI) data were recorded at the end of the surgery. The postoperative pain scores Face, Legs, Activity, Cry, Consolability (FLACC) were obtained in the emergence room 5 min after the children wake up. Receiver-operating characteristic curve was performed to analyze the predictive value of PTI, SPI, HR, and mean arterial pressure (MAP). The consistency between SPI and PTI was also evaluated. RESULTS Results showed that the areas under curves (95%CI) of PTI and SPI were 0.796 (95% CI: 0.694-0.895) and 0.753 (95% CI: 0.632-0.874), respectively, with the best cut-off value of 58 and 45 to discriminate between mild and moderate to severe pain. CONCLUSION This study suggested that PTI obtained at the end of the surgery could predict acute postoperative pain in children with an acceptable accuracy. It will help with early recognition and treatment of postoperative pain, thus reducing the pain in children. In addition, PTI had a good consistency with SPI in predicting acute postoperative pain in children.
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Affiliation(s)
- Jingjing Lv
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jianwei Zhang
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Kan Zhang
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jijian Zheng
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Center for Brain Science, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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9
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Abstract
The intraoperative dosing of opioids is a challenge in routine anesthesia as the potential effects of intraoperative overdosing and underdosing are not completely understood. In recent years an increasing number of monitors were approved, which were developed for the detection of intraoperative nociception and therefore should enable a better control of opioid titration. The nociception monitoring devices use either continuous hemodynamic, galvanic or thermal biosignals reflecting the balance between parasympathetic and sympathetic activity, measure the pupil dilatation reflex or the nociceptive flexor reflex as a reflexive response to application of standardized nociceptive stimulation. This review article presents the currently available nociception monitors. Most of these monitoring devices detect nociceptive stimulations with higher sensitivity and specificity than changes in heart rate, blood pressure or sedation depth monitoring devices. There are only few studies on the effect of opioid titration guided by nociception monitoring and the possible postoperative benefits of these devices. All nociception monitoring techniques are subject to specific limitations either due to perioperative confounders (e.g. hypovolemia) or special accompanying medical conditions (e.g. muscle relaxation). There is an ongoing discussion about the clinical relevance of nociceptive stimulation in general anesthesia and the effect on patient outcome. Initial results for individual monitor systems show a reduction in opioid consumption and in postoperative pain level. Nevertheless, current evidence does not enable the routine use of nociception monitoring devices to be recommended as a clear beneficial effect on long-term outcome has not yet been proven.
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10
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Recher M, Boukhris MR, Jeanne M, Storme L, Leteurtre S, Sabourdin N, De Jonckheere J. The newborn infant parasympathetic evaluation in pediatric and neonatology: a literature review. J Clin Monit Comput 2021; 35:959-966. [PMID: 33590418 DOI: 10.1007/s10877-021-00670-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 02/03/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE The Newborn Infant Parasympathetic Evaluation (NIPE) is a heart rate variability-based technology for assessing pain and comfort in neonates and infants under 2-years-old. This review aims to investigate the clinical utility of the NIPE. METHODS Two investigators screened Pubmed/Medline and Google Scholar for relevant studies, independently. One investigator extracted data, which were reviewed by a second investigator. RESULTS The NIPE was used during/after painful stimuli (6 studies), in the context of general anaesthesia (2 studies), and for comfort assessment (6 studies). A) Evaluation of procedural pain/distress: 2 studies reported that the mean-NIPE could be used for reliable monitoring of prolonged pain, and one study reported the association between instant-NIPE and pain after a stimulus but the instant-NIPE represents the NIPE average over 3 min. Two studies found no correlation between the NIPE and comfort behavior/pain scales, but they mainly differed in patients' gestational age and evaluation methodology. B) There are only 2 studies for the evaluation of nociception during surgery under general anaesthesia with contradictory results. C) Studies assessing neonates' comfort reported increased NIPE scores during skin-to-skin contact and during facilitated tucking associated with a human voice. No effect on NIPE scores of facilitated tucking during echocardiography was reported in preterm infants. One study reported significantly different NIPE scores with 2 surfactant therapy protocols. Overall, study populations were small and heterogeneous. CONCLUSION The results regarding NIPE's performances differ between studies. Given the limited number of studies and the heterogeneous outcomes, more studies are required to confirm the NIPE usefulness in the different clinical settings.
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Affiliation(s)
- Morgan Recher
- ULR 2694- METRICS: Evaluation des technologies de santé et des pratiques médicales, University of Lille, 59000, Lille, France. .,CHU Lille, Department of Pediatric Intensive Care, Jeanne de Flandre Hospital, 59000, Lille, France.
| | - Mohamed Riadh Boukhris
- ULR 2694- METRICS: Evaluation des technologies de santé et des pratiques médicales, University of Lille, 59000, Lille, France.,CHU Lille, Department of Neonatology, Jeanne de Flandre Hospital, 59000, Lille, France
| | - Mathieu Jeanne
- CHU Lille, CIC-IT 1403, Centre D'Innovation Technologique, 59000, Lille, France.,CHU Lille, Anesthesia and Critical Care, 59000, Lille, France.,ULR 7365 Groupe de Recherches Sur Les Formes Injectables Et Les Technologies Associées, University of Lille, 59000, Lille, France
| | - Laurent Storme
- ULR 2694- METRICS: Evaluation des technologies de santé et des pratiques médicales, University of Lille, 59000, Lille, France.,CHU Lille, Department of Neonatology, Jeanne de Flandre Hospital, 59000, Lille, France
| | - Stéphane Leteurtre
- ULR 2694- METRICS: Evaluation des technologies de santé et des pratiques médicales, University of Lille, 59000, Lille, France.,CHU Lille, Department of Pediatric Intensive Care, Jeanne de Flandre Hospital, 59000, Lille, France
| | - Nada Sabourdin
- APHP, Hôpital Armand-Trousseau, Anesthesia Department, DMU Dream, 75012, Paris, France
| | - Julien De Jonckheere
- ULR 2694- METRICS: Evaluation des technologies de santé et des pratiques médicales, University of Lille, 59000, Lille, France.,CHU Lille, CIC-IT 1403, Centre D'Innovation Technologique, 59000, Lille, France
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11
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Hernández-Avalos I, Flores-Gasca E, Mota-Rojas D, Casas-Alvarado A, Miranda-Cortés AE, Domínguez-Oliva A. Neurobiology of anesthetic-surgical stress and induced behavioral changes in dogs and cats: A review. Vet World 2021; 14:393-404. [PMID: 33776304 PMCID: PMC7994130 DOI: 10.14202/vetworld.2021.393-404] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 01/08/2021] [Indexed: 12/14/2022] Open
Abstract
The anesthetic-surgical stress response consists of metabolic, neuroendocrine, hemodynamic, immunological, and behavioral adaptations through chemical mediators such as the adrenocorticotropic hormone, growth hormone, antidiuretic hormone, cortisol, aldosterone, angiotensin II, thyroid-stimulating hormone, thyroxine, triiodothyronine, follicle-stimulating hormone, luteinizing hormone, catecholamines, insulin, interleukin (IL)-1, IL-6, tumor necrosis factor-alpha, and prostaglandin E-2. Behavioral changes include adopting the so-called prayer posture, altered facial expressions, hyporexia or anorexia, drowsiness, sleep disorders, restriction of movement, licking or biting the injured area, and vocalizations. Overall, these changes are essential mechanisms to counteract harmful stimuli. However, if uncontrolled surgical stress persists, recovery time may be prolonged, along with increased susceptibility to infections in the post-operative period. This review discusses the neurobiology and most relevant organic responses to pain and anesthetic-surgical stress in dogs and cats. It highlights the role of stress biomarkers and their influence on autonomous and demeanor aspects and emphasizes the importance of understanding and correlating all factors to provide a more accurate assessment of pain and animal welfare in dogs and cats throughout the surgical process.
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Affiliation(s)
- I Hernández-Avalos
- Department of Biological Sciences, Clinical Pharmacology and Veterinary Anesthesia, Faculty of Higher Studies Cuautitlán, Universidad Nacional Autónoma de México, State of Mexico 54714, Mexico
| | - E Flores-Gasca
- Department of Veterinary Surgery, Faculty of Higher Studies Cuautitlán, Universidad Nacional Autónoma de México, State of Mexico 54714, Mexico
| | - D Mota-Rojas
- Neurophysiology of Pain, Behavior and Assessment of Welfare in Domestic Animals, DPAA, Universidad Autónoma Metropolitana, Mexico City 04960, Mexico
| | - A Casas-Alvarado
- Master in Agricultural Sciences. Animal Welfare, Universidad Autónoma Metropolitana, Mexico City 04960, Mexico
| | - A E Miranda-Cortés
- Department of Biological Sciences, Clinical Pharmacology and Veterinary Anesthesia, Faculty of Higher Studies Cuautitlán, Universidad Nacional Autónoma de México, State of Mexico 54714, Mexico
| | - A Domínguez-Oliva
- Department of Biological Sciences, Clinical Pharmacology and Veterinary Anesthesia, Faculty of Higher Studies Cuautitlán, Universidad Nacional Autónoma de México, State of Mexico 54714, Mexico
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12
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Clinical Use of The Parasympathetic Tone Activity Index As a Measurement of Postoperative Analgaesia in Dogs Undergoing Ovariohysterectomy. J Vet Res 2021; 65:117-123. [PMID: 33817404 PMCID: PMC8009586 DOI: 10.2478/jvetres-2021-0004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 12/29/2020] [Indexed: 01/27/2023] Open
Abstract
Introduction While the current tools to assess canine postoperative pain using physiological and behavioural parameters are reliable, an objective method such as the parasympathetic tone activity (PTA) index could improve postoperative care. The aim of the study was to determine the utility of the PTA index in assessing postoperative analgaesia. Material and Methods Thirty healthy bitches of different breeds were randomly allocated into three groups for analgaesic treatment: the paracetamol group (GPARAC, n = 10) received 15 mg/kg b.w., the carprofen group (GCARP, n = 10) 4 mg/kg b.w., and the meloxicam group (GMELOX, n = 10) 0.2 mg/kg b.w. for 48 h after surgery. GPARAC was medicated orally every 8 h, while GCARP and GMELOX were medicated intravenously every 24 h. The PTA index was used to measure the analgaesia–nociception balance 1 h before surgery (baseline), and at 1, 2, 4, 6, 8, 12, 16, 20, 24, 36, and 48 h after, at which times evaluation on the University of Melbourne Pain Scale (UMPS) was made. Results The baseline PTA index was 65 ± 8 for GPARAC, 65 ± 7 for GCARP, and 62 ± 5 for GMELOX. Postoperatively, it was 65 ± 9 for GPARAC, 63 ± 8 for GCARP, and 65 ± 8 for GMELOX. No statistically significant difference existed between baseline values or between values directly after treatments (P = 0.99 and P = 0.97, respectively). The PTA index showed a sensitivity of 40%, specificity of 98.46% and a negative predictive value of 99.07%. Conclusion Our findings suggest that the PTA index measures comfort and postoperative analgaesia objectively, since it showed a clinical relationship with the UMPS.
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13
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ANI and BIS variations in supine and prone position during closed-tracheal suction in sedated and myorelaxed ICU patients with severe COVID-19: A retrospective study. J Clin Monit Comput 2020; 35:1403-1409. [PMID: 33159268 PMCID: PMC7646496 DOI: 10.1007/s10877-020-00612-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/21/2020] [Indexed: 12/11/2022]
Abstract
The purpose of this study was to assess Analgesia/Nociception Index (ANI) and bispectral index (BIS) variations in supine and prone position during closed-tracheal suction in intensive care unit (ICU) patients with severe COVID-19 pneumonia requiring myorelaxation and prone positioning. We retrospectively reviewed the data of 15 patients hospitalized in ICU for severe COVID-19 pneumonia requiring sedation, myorelaxation and prone positioning. The BIS, instant ANI (ANIi), mean ANI (ANIm), heart rate (HR), systolic blood pressure (SBP) and SpO2 were retrieved in supine and prone position 1 min before tracheal suction then every minute from the beginning of tracheal suction during 4 min and compared using ANOVA for repeated measures (p < 0.05 considered as statistically significant). Both ANIm and ANIi decreased significantly during tracheal suction with no difference between positions, whereas BIS showed no significant variation within time and between groups. The median [Q1–Q3] ANIm value decreased from 87 [68–98] to 79 [63–09] in supine position and from 79 [63–95] to 78 [66–98] in prone position 2 min after the beginning of tracheal suction. The median [Q1–Q3] ANIi value decreased earlier 1 min after the beginning of tracheal suction from 84 [69–98] to 73 [60–90] in supine position and from 84 [60–99] to 71 [51–88] in prone position. Both HR, SBP and SpO2 varied modestly but significantly during tracheal suction with no difference between positions. Monitoring ANI, but not BIS, may be of interest to detect noxious stimuli such as tracheal suction in ICU myorelaxed patients with severe COVID-19 pneumonia requiring prone positioning.
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14
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Wey PF, Loheas D, Lamblin A, Riche B, Rabilloud M, Escarment J, Puidupin M, Quintin L, Martinez JY, Cividjian A. A beat-by-beat cardiovascular index, CARDEAN, to titrate opioid administration in the setting of orthopaedic surgery: a prospective randomized trial. J Clin Monit Comput 2020; 35:1311-1324. [PMID: 33025323 DOI: 10.1007/s10877-020-00597-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 09/21/2020] [Indexed: 11/25/2022]
Abstract
To determine whether a beat-by-beat cardiovascular index (CARDEAN: cardiovascular depth of analgesia, Alpha-2 Ltd, Lyon, France) reduces the incidence of tachycardia in ASA I-III patients undergoing orthopaedic surgery. A total of 76 patients were prospectively randomized into (1) a control group or (2) the CARDEAN group, in which the nurse anaesthetist was blinded to CARDEAN application. In addition to conventional signs, an external observer instructed the nurse anaesthetist to administer sufentanil 0.1 µg kg-1 when the CARDEAN crossed a threshold (≥ 60). The primary outcome was the incidence of tachycardia (> 120% of reference heart rate, HR). Non-invasive blood pressure (BP), electrocardiogram (ECG), O2 saturation-photoplethysmography and the bispectral index (40 < BIS < 60) were monitored. HR and an estimation of beat-by-beat BP changes acquired from photoplethysmography and ECG were combined in an algorithm that detected hypertension followed by tachycardia (index scaled 0-100). Sufentanil 0.1 µg kg-1 was administered when tachycardia, hypertension or movement ("conventional signs") was observed. Data for 66 patients (27 with known hypertension) were analysed. In the CARDEAN group, (a) the dose of sufentanil was higher (control: 0.46 µg kg-1 100 min-1, CARDEAN: 0.57 µg kg-1 100 min-1, p = 0.016), (b) the incidence rates of tachycardia and untoward events were lower (respectively: - 44%; control: 2.52 events 100 min-1 [1.98-3.22]; CARDEAN: 1.42 [1.03-1.96], p = 0.005, hazard ratio: 0.56; movement, muscular contraction, or coughing: control: 0.74 events 100 min-1 [0.47-1.16]; CARDEAN: 0.31 [0.15-0.62], p = 0.038), and (c) extubation occurred more often in the operating room (control: 76.5%, CARDEAN: 97%, p = 0.016). CARDEAN-titrated opioid administration was associated with a higher dose of sufentanil, a reduction in tachycardia and earlier emergence in ASA I-III patients undergoing major orthopaedic surgery.
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Affiliation(s)
| | - Damien Loheas
- Anaesthesia, Hôpital D'Instruction Des Armées Desgenettes, Lyon, France
| | - Antoine Lamblin
- Anaesthesia, Hôpital D'Instruction Des Armées Desgenettes, Lyon, France
| | - Benjamin Riche
- CNRS UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Biostatistique et Santé, Lyon, France
| | - Muriel Rabilloud
- CNRS UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Biostatistique et Santé, Lyon, France
| | - Jacques Escarment
- Anaesthesia, Hôpital D'Instruction Des Armées Desgenettes, Lyon, France
| | - Marc Puidupin
- Anaesthesia, Hôpital D'Instruction Des Armées Desgenettes, Lyon, France
| | - Luc Quintin
- Anaesthesia, Hôpital D'Instruction Des Armées Desgenettes, Lyon, France.
- Alpha-2 Ltd, Lyon, France.
| | | | - Andrei Cividjian
- Anaesthesia, Hôpital D'Instruction Des Armées Desgenettes, Lyon, France
- Alpha-2 Ltd, Lyon, France
- Immunologie Cellulaire EA 7426, Univ Lyon, Université Claude Bernard Lyon 1, Lyon, France
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15
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Physiological Measures of Acute and Chronic Pain within Different Subject Groups: A Systematic Review. Pain Res Manag 2020; 2020:9249465. [PMID: 32952747 PMCID: PMC7487119 DOI: 10.1155/2020/9249465] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/27/2020] [Indexed: 11/17/2022]
Abstract
Results The methods' heart rate variability and electroencephalogram show clear and consistent results as acute pain assessment. Magnetic resonance imaging can measure chronic pain. Ordered by invasiveness and vulnerability, a trend shows that the invasive methods are used more with less vulnerable subjects. Only instruments used for skin conductance and automatic facial recognition have a lower-than-average technological maturity. Conclusions Some pain assessment methods show good and consistent results and have high technological maturity; however, using them as pain assessment for persons with ID is uncommon. Since this addition can ameliorate caregiving, more research of assessment methods should occur.
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16
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Vide S, Castro A, Correia R, Cabral T, Lima D, Nunes CS, Gambús P, Amorim P. Foreseeing postoperative pain in neurosurgical patients: pupillometry predicts postoperative pain ratings-an observational study. J Clin Monit Comput 2020; 35:1111-1118. [PMID: 32729066 DOI: 10.1007/s10877-020-00570-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 07/23/2020] [Indexed: 01/03/2023]
Abstract
Pupillary reflex dilation (PRD) is triggered by noxious stimuli and diminished by opioid administration. In the postoperative period, PRD has been shown to be correlated with pain reporting and a useful tool to guide opioid administration. In this study we assessed whether pupillary measurements taken before extubation were related with the patient's reported pain in the Post-Anesthesia Care Unit (PACU) using the Numerical Rating Scale (NRS). Our objective was to evaluate the correlation of PRD and pupillary variables measured intraoperatively with postoperative pain under the same opioid concentration. This was a prospective observational study of 26 neurosurgical patients undergoing general anesthesia exclusively with propofol and remifentanil. A portable infrared pupillometer was used to provide an objective measure of pupil size and PRD (using the Pupillary Pain Index) before extubation. Pain ratings were obtained from patients after recovery of consciousness, while remifentanil was maintained at 2 ng/mL. A significant correlation was observed between NRS scores and pre-extubation PPI (rS = 0.62; P = 0.002), as well as between NRS scores and pupil diameter before tetanic stimulation PPI (rS = 0.56, P = 0.006). We also found a negative correlation between pupil diameter and age (rS = - 0.42, P = 0.04). The statistically significant correlation between pre-extubation PPI scores and NRS scores, as well as between the pupillary diameter before tetanic stimulation and NRS scores suggest the possibility of titrating analgesia at the end of the intraoperative period based on individual responses. This could allow clinicians to identify the ideal remifentanil concentration for the postoperative period.
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Affiliation(s)
- Sérgio Vide
- Department of Anesthesia, Unidade Local de Saúde de Matosinhos - Hospital Pedro Hispano, R. de Dr. Eduardo Torres, 4464-513, Matosinhos, Portugal. .,Department of Anesthesiology, Center for Clinical Research in Anesthesia, Centro Hospitalar do Porto, Porto, Portugal. .,Systems Pharmacology Effect Control & Modeling (SPEC-M) Research Group, Anesthesiology Department, Hospital CLINIC de Barcelona, Barcelona, Spain.
| | - Ana Castro
- Hospital Santa Maria Maior, Barcelos, Portugal
| | - Rui Correia
- Department of Anesthesiology, Center for Clinical Research in Anesthesia, Centro Hospitalar do Porto, Porto, Portugal
| | - Tiago Cabral
- Department of Anesthesia, Hospital Divino Espírito Santo, Ponta Delgada, Portugal
| | - Deolinda Lima
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Catarina S Nunes
- Department of Anesthesiology, Center for Clinical Research in Anesthesia, Centro Hospitalar do Porto, Porto, Portugal.,Department of Sciences and Technology, Universidade Aberta, Porto, Portugal
| | - Pedro Gambús
- Systems Pharmacology Effect Control & Modeling (SPEC-M) Research Group, Anesthesiology Department, Hospital CLINIC de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), NeuroImmunology Research Group, Barcelona, Spain
| | - Pedro Amorim
- Department of Anesthesiology, Center for Clinical Research in Anesthesia, Centro Hospitalar do Porto, Porto, Portugal
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17
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Köprülü AŞ, Haspolat A, Gül YG, Tanrikulu N. Can postoperative pain be predicted? New parameter: analgesia nociception index. Turk J Med Sci 2020; 50. [PMID: 31731328 PMCID: PMC7080375 DOI: 10.3906/sag-1811-194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 10/29/2019] [Indexed: 11/03/2022] Open
Abstract
Background/aim The Analgesia Nociception Index (ANI) is a new method of identifying nociception-analgesia balance. In this study, we investigate the correlation between the ANI and numeric rating scale (NRS) values immediately before and after extubation. The NRS values were recorded in the postanesthesia care unit, in a group of patients who underwent laparoscopic cholecystectomy, with the aim of evaluating the potential use of ANI values in the prediction of postoperative pain levels. Materials and methods The ANI and NRS values, heartbeat rate (HR), systolic and diastolic arterial pressure (SAP/DAP), and oxygen saturation (SpO2) values of the patients were recorded into three groups based on the initial NRS values recorded in the postanesthesia care unit (group I: NRS ≤ 3, group II: NRS 4–6, group III: NRS ≥ 7). Patients whose ANI values were lower than 47, considered as the pain threshold, and the groups to which these patients belonged were also recorded. Results Statistically significant increases were noted in HR, SAP, and DAP after extubation, while there was no significant change in ANI values. A weak correlation was identified between the ANI and NRS values of all patient groups. Conclusion We failed to identify a correlation between ANI and NRS values before and after extubation. Previous studies suggested that the ANI provides more valuable information in anesthetized patients, whereas our findings show that it is ineffective in the prediction of potential postoperative pain.
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Affiliation(s)
- Ali Şefik Köprülü
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, İstanbul Yeni Yüzyıl University, İstanbul, Turkey
| | - Ali Haspolat
- Anesthesia and Intensive Care Clinics, İstanbul Şişli Vocational High School, İstanbul, Turkey
| | - Yaşar Gökhan Gül
- Anesthesiology Clinics, Kolan Bayrampaşa Hospital, İstanbul, Turkey
| | - Nurşen Tanrikulu
- Anesthesia and Intensive Care Clinics, İstanbul Şişli Vocational High School, İstanbul, Turkey
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18
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Wu L, Wang S, Wang Y, Zhang K, Bai J, Zheng J. Prediction of Hemodynamic Reactivity by Electroencephalographically Derived Pain Threshold Index in Children Undergoing General Anesthesia: A Prospective Observational Study. J Pain Res 2019; 12:3245-3255. [PMID: 31819608 PMCID: PMC6899069 DOI: 10.2147/jpr.s231596] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 11/15/2019] [Indexed: 12/17/2022] Open
Abstract
Purpose The pain threshold index (PTI) is a novel measure of nociception based on integrated electroencephalogram parameters during general anesthesia. The wavelet index (WLI) reflects the depth of sedation. This study aims to evaluate the ability of the PTI and WLI to predict hemodynamic reactivity after tracheal intubation and skin incision in pediatric patients. Patients and methods Pediatric patients (n=134) undergoing elective general surgery or urinary surgery were analyzed. Measurements at predefined time-points during tracheal intubation and skin incision included the PTI, WLI, heart rate (HR), and mean blood pressure (MBP). Receiver-operating characteristic (ROC) curves were computed to evaluate the predictive performance of the PTI and WLI in measuring hemodynamic reactivity (an increase of more than 20% in either MBP or HR) during general anesthesia. Results Of the 134 patients evaluated, positive reactivity of HR and MBP was observed in 95 (70.9%) and 61 (45.5%) patients induced by intubation, respectively, and 19 (14.2%) and 24 (17.9%) patients induced by skin incision, respectively. Using either HR or MBP reactivity induced by intubation as a dichotomous variable, the areas under the curves (AUCs) [95% CI] of PTI and WLI were 0.81[0.73–0.87] and 0.58[0.49–0.67] with the best cutoff values of 62 and 49. The AUCs [95% CI] of PTI and WLI were 0.82[0.75–0.88] and 0.61[0.52–0.69] after skin incision. The best cutoff values of PTI and WLI were 60 and 46, respectively. Conclusion The PTI can predict hemodynamic reactivity with the best cutoff values of 62 and 60 after tracheal intubation and skin incision in pediatric patients during general anesthesia. The WLI failed in predicting hemodynamic changes.
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Affiliation(s)
- Lei Wu
- Department of Anesthesiology, Shanghai Children's Medical Center Affiliated to School of Medicine, Shanghai Jiao Tong University, Pudong, Shanghai, People's Republic of China
| | - Siyuan Wang
- Department of Anesthesiology, 3201 Hospital, Hanzhong City, Shaanxi, People's Republic of China
| | - Yanting Wang
- Department of Anesthesiology, Shanghai Children's Medical Center Affiliated to School of Medicine, Shanghai Jiao Tong University, Pudong, Shanghai, People's Republic of China
| | - Kan Zhang
- Department of Anesthesiology, Shanghai Children's Medical Center Affiliated to School of Medicine, Shanghai Jiao Tong University, Pudong, Shanghai, People's Republic of China
| | - Jie Bai
- Department of Anesthesiology, Shanghai Children's Medical Center Affiliated to School of Medicine, Shanghai Jiao Tong University, Pudong, Shanghai, People's Republic of China
| | - Jijian Zheng
- Department of Anesthesiology, Shanghai Children's Medical Center Affiliated to School of Medicine, Shanghai Jiao Tong University, Pudong, Shanghai, People's Republic of China.,Pediatric Clinical Pharmacology Laboratory, Shanghai Children's Medical Center Affiliated to School of Medicine, Shanghai Jiao Tong University, Pudong, Shanghai, People's Republic of China
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19
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Hernandez-Avalos I, Mota-Rojas D, Mora-Medina P, Martínez-Burnes J, Casas Alvarado A, Verduzco-Mendoza A, Lezama-García K, Olmos-Hernandez A. Review of different methods used for clinical recognition and assessment of pain in dogs and cats. Int J Vet Sci Med 2019; 7:43-54. [PMID: 31819890 PMCID: PMC6882480 DOI: 10.1080/23144599.2019.1680044] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/07/2019] [Accepted: 10/09/2019] [Indexed: 12/28/2022] Open
Abstract
In light of the need to perform surgical techniques and the importance of animal welfare because of acute pain, the objectives of the veterinary anaesthetists are to manage muscle relaxation and adequate analgesia in order to conserve a balance in the autonomic nervous system, enhance the action of the parasympathetic system in the face of the emerging action of the sympathetic portion provoked by the surgeon, and maintain a balance among them. The aim of the present review is to describe different evaluation criteria for acute pain using unidimensional and multidimensional scales, correlating these findings to parasympathetic tone activity (PTA) and bispectral index (BIS) assessment, to conduct an objective evaluation of pain that patients (dog or cat) perceives, in order to administrate an adequate analgesic treatment in each case. In conclusion, this integral, objective evaluation will allow veterinarians – especially anaesthesiologists – to improve the management of pain in the patients.
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Affiliation(s)
| | - Daniel Mota-Rojas
- Neurophysiology of Pain, Behavior and Assessment of Welfare in Domestic Animals, DPAA, Universidad Autónoma Metropolitana (UAM), Mexico City, Mexico
| | - Patricia Mora-Medina
- Livestock Science Department, Universidad Nacional Autónoma de México (UNAM), FESC, Mexico
| | - Julio Martínez-Burnes
- Graduate and Research Department, Facultad de Medicina Veterinaria y Zootecnia, Universidad Autónoma de Tamaulipas, Victoria City, Tamaulipas, Mexico
| | - Alejandro Casas Alvarado
- Neurophysiology of Pain, Behavior and Assessment of Welfare in Domestic Animals, DPAA, Universidad Autónoma Metropolitana (UAM), Mexico City, Mexico
| | - Antonio Verduzco-Mendoza
- Departamento Bioterio y Cirugía Experimental, Instituto Nacional de Rehabilitación-Luis Guillermo Ibarra Ibarra (INR-LGII), Mexico City, Mexico
| | - Karina Lezama-García
- Neurophysiology of Pain, Behavior and Assessment of Welfare in Domestic Animals, DPAA, Universidad Autónoma Metropolitana (UAM), Mexico City, Mexico
| | - Adriana Olmos-Hernandez
- Departamento Bioterio y Cirugía Experimental, Instituto Nacional de Rehabilitación-Luis Guillermo Ibarra Ibarra (INR-LGII), Mexico City, Mexico
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20
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Ghanty I, Schraag S. The quantification and monitoring of intraoperative nociception levels in thoracic surgery: a review. J Thorac Dis 2019; 11:4059-4071. [PMID: 31656682 DOI: 10.21037/jtd.2019.08.62] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Nociception is the unconscious perception of a stimulus applied by trauma or surgery and expressed through a response of the autonomous nervous system. Local anaesthetics (LAs), opioids and other modulating agents such as ketamine are usually utilised to blunt nociception as a component during general anaesthesia (GA) and surgery. The effectiveness of these measures, however, are still difficult to quantify and monitoring of anti-nociception has been confined to assess variation of heart rate (HR) or blood pressure (BP). Recently, various monitoring concepts have been introduced to quantify nociception more systematically and on the other hand guide anti-nociceptive interventions more appropriately. This review describes the various technologies, their performance in clinical studies and provides a critical appraisal with particular application to thoracic anaesthesia and surgery and their relevance in the context of chronic pain after surgery.
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Affiliation(s)
- Ismael Ghanty
- Department of Perioperative Medicine, Golden Jubilee National Hospital, Clydebank, UK
| | - Stefan Schraag
- Department of Perioperative Medicine, Golden Jubilee National Hospital, Clydebank, UK
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21
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Stöckle PA, Julien M, Issa R, Décary E, Brulotte V, Drolet P, Henri M, Poirier M, Latulippe JF, Dorais M, Verdonck O, Fortier LP, Richebé P. Validation of the PMD100 and its NOL Index to detect nociception at different infusion regimen of remifentanil in patients under general anesthesia. Minerva Anestesiol 2018; 84:1160-1168. [DOI: 10.23736/s0375-9393.18.12720-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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22
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Boselli E, Jacquet-Lagrèze M, Ayoub JY, Bouvet L, Dauwalder O, Mansour C, Margez T, Paquet C, Restagno D, Allaouchiche B, Bonnet-Garin JM, Junot S. Effects of esmolol on systemic hemodynamics and heart rate variability measured using the Analgesia/Nociception Index in resuscitated piglets with Pseudomonas aeruginosa septic shock. J Vet Emerg Crit Care (San Antonio) 2018; 28:447-456. [PMID: 30074662 DOI: 10.1111/vec.12756] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 08/04/2016] [Accepted: 08/26/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the effects of esmolol on hemodynamics and heart rate variability (HRV) in the early stage of sepsis. DESIGN Prospective, randomized, controlled, parallel trial. SETTINGS Veterinary research laboratory. ANIMALS Ten anesthetized piglets. INTERVENTIONS Septic shock was induced by infusing a suspension of live Pseudomonas aeruginosa IV in 10 anesthetized piglets. The piglets were resuscitated according to a standardized protocol using Ringer's lactate solution, norepinephrine, and milrinone. Once stabilized, the piglets were randomized to receive IV esmolol, titrated to a heart rate <90/min, or control, receiving saline. A pulmonary artery catheter and an arterial catheter were inserted for hemodynamic measurements. The Analgesia/Nociception Index (ANI) and the normalized HRV frequency domain parameters - high-frequency (HF), low frequency (LF), LF/HF ratio - were recorded using a proprietary monitor. MEASUREMENTS AND MAIN RESULTS A significant decrease in cardiac output and heart rate, and a significant increase in systemic vascular resistance were observed over time in the esmolol group in comparison to the control group. No other differences were observed in hemodynamic parameters. No significant differences were observed in ANI variations or HRV parameters over time between groups. CONCLUSIONS The administration of esmolol produced significant changes in hemodynamics with no change in ANI values or HRV parameters. Further study is needed to understand the effect of esmolol during sepsis.
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Affiliation(s)
- Emmanuel Boselli
- VetAgro Sup UPSP 2016.A101- Campus vétérinaire de Lyon, Agressions Pulmonaires et Circulatoires dans le Sepsis (APCSe), Marcy-l'Étoile, France, Université Lyon I Claude Bernard, Université de Lyon, Lyon, France
| | - Matthias Jacquet-Lagrèze
- VetAgro Sup UPSP 2016.A101- Campus vétérinaire de Lyon, Agressions Pulmonaires et Circulatoires dans le Sepsis (APCSe), Marcy-l'Étoile, France, Université Lyon I Claude Bernard, Université de Lyon, Lyon, France.,Service de réanimation médicale, Centre hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Jean-Yves Ayoub
- VetAgro Sup UPSP 2016.A101- Campus vétérinaire de Lyon, Agressions Pulmonaires et Circulatoires dans le Sepsis (APCSe), Marcy-l'Étoile, France, Université Lyon I Claude Bernard, Université de Lyon, Lyon, France
| | - Lionel Bouvet
- VetAgro Sup UPSP 2016.A101- Campus vétérinaire de Lyon, Agressions Pulmonaires et Circulatoires dans le Sepsis (APCSe), Marcy-l'Étoile, France, Université Lyon I Claude Bernard, Université de Lyon, Lyon, France.,Service d'anesthésie-réanimation, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Bron, France
| | - Olivier Dauwalder
- Laboratoire de bactériologie, Centre de biologie Est, Hospices Civils de Lyon, Bron, France
| | - Christelle Mansour
- VetAgro Sup UPSP 2016.A101- Campus vétérinaire de Lyon, Agressions Pulmonaires et Circulatoires dans le Sepsis (APCSe), Marcy-l'Étoile, France, Université Lyon I Claude Bernard, Université de Lyon, Lyon, France
| | - Thomas Margez
- Département de recherche et développement, MDoloris Medical Systems, Lille, France
| | - Christian Paquet
- VetAgro Sup UPSP 2016.A101- Campus vétérinaire de Lyon, Agressions Pulmonaires et Circulatoires dans le Sepsis (APCSe), Marcy-l'Étoile, France, Université Lyon I Claude Bernard, Université de Lyon, Lyon, France
| | - Damien Restagno
- VetAgro Sup UPSP 2016.A101- Campus vétérinaire de Lyon, Agressions Pulmonaires et Circulatoires dans le Sepsis (APCSe), Marcy-l'Étoile, France, Université Lyon I Claude Bernard, Université de Lyon, Lyon, France
| | - Bernard Allaouchiche
- VetAgro Sup UPSP 2016.A101- Campus vétérinaire de Lyon, Agressions Pulmonaires et Circulatoires dans le Sepsis (APCSe), Marcy-l'Étoile, France, Université Lyon I Claude Bernard, Université de Lyon, Lyon, France.,Service de réanimation médicale, Centre hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Jeanne-Marie Bonnet-Garin
- VetAgro Sup UPSP 2016.A101- Campus vétérinaire de Lyon, Agressions Pulmonaires et Circulatoires dans le Sepsis (APCSe), Marcy-l'Étoile, France, Université Lyon I Claude Bernard, Université de Lyon, Lyon, France
| | - Stéphane Junot
- VetAgro Sup UPSP 2016.A101- Campus vétérinaire de Lyon, Agressions Pulmonaires et Circulatoires dans le Sepsis (APCSe), Marcy-l'Étoile, France, Université Lyon I Claude Bernard, Université de Lyon, Lyon, France
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23
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Hirose M, Kobayashi Y, Nakamoto S, Ueki R, Kariya N, Tatara T. Development of a Hemodynamic Model Using Routine Monitoring Parameters for Nociceptive Responses Evaluation During Surgery Under General Anesthesia. Med Sci Monit 2018; 24:3324-3331. [PMID: 29779036 PMCID: PMC5990992 DOI: 10.12659/msm.907484] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Routine hemodynamic monitoring parameters under general anesthesia, such as heart rate (HR), systolic blood pressure (SBP), and perfusion index (PI), do not solely reflect intraoperative nociceptive levels. We developed a hemodynamic model combining these 3 parameters for nociceptive responses during general anesthesia, and evaluated nociceptive responses to surgical skin incision. MATERIAL AND METHODS We first retrospectively performed discriminant analysis using 3 values - HR, SBP, and PI - to assess response to skin incision during tympanoplasty, laparoscopic cholecystectomy, and open gastrectomy to determine if combined use of these parameters differentiates nociceptive levels among these 3 surgeries. Secondly, ordinal logistic regression analysis was applied using the 3 parameters to develop an equation representing nociceptive response during general anesthesia, and then evaluated its utility to discern nociceptive responses to skin incision. RESULTS We developed the following hemodynamic model as calculated nociceptive response= -1+2/(1+ exp(-0.01 HR -0.02 SBP +0.17 PI)), and prospectively determined that calculated nociceptive responses to small skin incision for laparoscopic surgery were significantly lower than responses to large skin incision for laparotomy. CONCLUSIONS Our hemodynamic model using HR, SBP, and PI likely reflects nociceptive levels at skin incision during general anesthesia, and quantitatively discerned the difference in nociceptive responses to skin incision between laparoscopy and laparotomy. This model could be applicable to assess either real-time nociceptive responses or averaged nociceptive responses throughout surgery without using special equipment.
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Affiliation(s)
- Munetaka Hirose
- Department of Anesthesiology and Pain Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Yoshiko Kobayashi
- Department of Anesthesiology and Pain Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Shiro Nakamoto
- Department of Anesthesiology and Pain Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Ryusuke Ueki
- Department of Anesthesiology and Pain Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Nobutaka Kariya
- Department of Anesthesiology and Pain Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Tsuneo Tatara
- Department of Anesthesiology and Pain Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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24
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Wildemeersch D, Peeters N, Saldien V, Vercauteren M, Hans G. Pain assessment by pupil dilation reflex in response to noxious stimulation in anaesthetized adults. Acta Anaesthesiol Scand 2018; 62:1050-1056. [PMID: 29671874 PMCID: PMC6099429 DOI: 10.1111/aas.13129] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 03/05/2018] [Accepted: 03/08/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND In response to noxious stimulation, pupillary dilation reflex (PDR) occurs even in anaesthetized patients. The aim of the study was to evaluate the ability of pupillometry with an automated increasing stimulus intensity to monitor intraoperative opioid administration. METHODS Thirty-four patients undergoing elective surgery were enrolled. Induction by propofol anaesthesia was increased progressively until the sedation depth criteria (SeD) were attained. Subsequently, a first dynamic pupil measurement was performed by applying standardized nociceptive stimulation (SNS). A second PDR evaluation was performed when remifentanil reached a target effect-site concentration. Automated infrared pupillometry was used to determine PDR during nociceptive stimulations generating a unique pupillary pain index (PPI). Vital signs were measured. RESULTS After opioid administration, anaesthetized patients required a higher stimulation intensity (57.43 mA vs 32.29 mA, P < .0005). Pupil variation in response to the nociceptive stimulations was significantly reduced after opioid administration (8 mm vs 28 mm, P < .0005). The PPI score decreased after analgesic treatment (8 vs 2, P < .0005), corresponding to a 30% decrease. The elicitation of PDR by nociceptive stimulation was performed without changes in vital signs before (HR 76 vs 74/min, P = .09; SBP 123 vs 113 mm Hg, P = .001) and after opioid administration (HR 63 vs 62/min, P = .4; SBP 98.66 vs 93.77 mm Hg, P = .032). CONCLUSIONS During propofol anaesthesia, pupillometry with the possibility of low-intensity standardized noxious stimulation via PPI protocol can be used for PDR assessment in response to remifentanil administration.
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Affiliation(s)
- D. Wildemeersch
- Department of AnaesthesiaAntwerp University Hospital (UZA)EdegemBelgium
- Multidisciplinary Pain CentreAntwerp University Hospital (UZA)EdegemBelgium
- Laboratory for Pain ResearchUniversity of Antwerp (UA)WilrijkBelgium
| | - N. Peeters
- Department of AnaesthesiaAntwerp University Hospital (UZA)EdegemBelgium
| | - V. Saldien
- Department of AnaesthesiaAntwerp University Hospital (UZA)EdegemBelgium
| | - M. Vercauteren
- Multidisciplinary Pain CentreAntwerp University Hospital (UZA)EdegemBelgium
- Laboratory for Pain ResearchUniversity of Antwerp (UA)WilrijkBelgium
| | - G. Hans
- Department of AnaesthesiaAntwerp University Hospital (UZA)EdegemBelgium
- Multidisciplinary Pain CentreAntwerp University Hospital (UZA)EdegemBelgium
- Laboratory for Pain ResearchUniversity of Antwerp (UA)WilrijkBelgium
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25
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Wildemeersch D, Baeten M, Peeters N, Saldien V, Vercauteren M, Hans G. Pupillary dilation reflex and pupillary pain index evaluation during general anaesthesia: a pilot study. Rom J Anaesth Intensive Care 2018; 25:19-23. [PMID: 29756058 DOI: 10.21454/rjaic.7518.251.wil] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Background Pupillary response by pupillary dilatation reflex (PDR) is a robust reflex, even measurable during general anaesthesia. However, the ability of infrared pupillometry to detect PDR differences obtained by intraoperative opioid administration in anaesthesized patients remains largely unknown. We analyzed the performance of automated infrared pupillometry in detecting differences in pupillary dilatation reflex response by a inbuilt standardized nociceptive stimulation program in patients under general anesthesia with a standardized propofol/fentanyl scheme. Methods In this single center, interventional cohort study 38 patients (24-74 years) were enrolled. Patients were anesthetized with propofol until loss of consciousness. Two dynamic pupil measurements were performed in each patient (before opioid administration and after opioid steady state). Automated infrared pupillometry was used to determine PDR during nociceptive stimulations (10-60 mA) applied by a inbuilt pupillary pain index protocol (PPI) to the skin area innervated by the median nerve. Increasing stimulations by protocol are device specific and automatically performed until pupil dilation of > 13%. Pupil characteristics, blood pressure, heart rate values were collected. Results After opioid administration, patients needed a higher stimulation intensity (45.26 mA vs 30.79 mA, p = 0.00001). PPI score showed a reduction after analgesic treatment (5.21 vs 7.68, p = 0.000001), resulting in a 32.16% score reduction. Conclusions PDR via automated increased tetanic stimulation may reflect opioid effect under general anaesthesia. Further research is required to detect possible confounding factors such as medication interaction and optimization of individualized opioid dosage.
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Affiliation(s)
- Davina Wildemeersch
- Department of Anaesthesiology, Antwerp University Hospital, Edegem, Belgium.,Multidisciplinary Pain Centre, Antwerp University Hospital, Edegem, Belgium.,Pain Research Laboratory, University of Antwerp, Edegem, Belgium
| | - Michiel Baeten
- Department of Anaesthesiology, Antwerp University Hospital, Edegem, Belgium
| | - Natasja Peeters
- Department of Anaesthesiology, Antwerp University Hospital, Edegem, Belgium
| | - Vera Saldien
- Department of Anaesthesiology, Antwerp University Hospital, Edegem, Belgium
| | - Marcel Vercauteren
- Multidisciplinary Pain Centre, Antwerp University Hospital, Edegem, Belgium.,Pain Research Laboratory, University of Antwerp, Edegem, Belgium
| | - Guy Hans
- Department of Anaesthesiology, Antwerp University Hospital, Edegem, Belgium.,Multidisciplinary Pain Centre, Antwerp University Hospital, Edegem, Belgium.,Pain Research Laboratory, University of Antwerp, Edegem, Belgium
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26
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Boselli E, Musellec H, Bernard F, Guillou N, Hugot P, Augris-Mathieu C, Diot-Junique N, Bouvet L, Allaouchiche B. EFFECTS OF CONVERSATIONAL HYPNOSIS ON RELATIVE PARASYMPATHETIC TONE AND PATIENT COMFORT DURING AXILLARY BRACHIAL PLEXUS BLOCKS FOR AMBULATORY UPPER LIMB SURGERY:A Quasiexperimental Pilot Study. Int J Clin Exp Hypn 2018; 66:134-146. [PMID: 29601275 DOI: 10.1080/00207144.2018.1421355] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This two-center quasiexperimental pilot study was to determine the effect of conversational hypnosis on patient comfort and parasympathetic tone, which may represent a quantitative measure of hypnotic depth, during regional anesthesia. The patients received conversational hypnosis in one center and oral premedication in the other. The patients' subjective comfort (0-10 rating scale) and objective parasympathetic tone, as assessed by the Analgesia/Nociception Index (ANI), were measured before and after regional anesthesia. The parasympathetic tone and comfort scores evidenced a significantly greater increase in the hypnosis patients than in controls. These findings suggest that using conversational hypnosis during regional anesthesia may be followed by a subjective increase in patient comfort and an objective increase in parasympathetic tone, monitored by ANI.
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Affiliation(s)
- Emmanuel Boselli
- a University of Lyon, University Lyon I Claude Bernard, APCSe VetAgroSup UPSP 2016.A101 , Lyon , France
| | - Hervé Musellec
- c Centre hospitalier privé Saint-Grégoire , Saint-Grégoire , France
| | - Franck Bernard
- c Centre hospitalier privé Saint-Grégoire , Saint-Grégoire , France
| | - Nicolas Guillou
- c Centre hospitalier privé Saint-Grégoire , Saint-Grégoire , France
| | - Pierre Hugot
- c Centre hospitalier privé Saint-Grégoire , Saint-Grégoire , France
| | | | | | - Lionel Bouvet
- a University of Lyon, University Lyon I Claude Bernard, APCSe VetAgroSup UPSP 2016.A101 , Lyon , France
| | - Bernard Allaouchiche
- a University of Lyon, University Lyon I Claude Bernard, APCSe VetAgroSup UPSP 2016.A101 , Lyon , France
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27
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Effects of hypnosis on the relative parasympathetic tone assessed by ANI (Analgesia/Nociception Index) in healthy volunteers: a prospective observational study. J Clin Monit Comput 2017; 32:487-492. [PMID: 28825157 DOI: 10.1007/s10877-017-0056-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 08/17/2017] [Indexed: 10/19/2022]
Abstract
Hypnosis has shown an effect on the regulation of the autonomic nervous system by increasing parasympathetic activity. The Analgesia/Nociception Index (ANI) is derived from heart rate variability and represents the relative parasympathetic tone. We investigated the effects of hypnosis on ANI in healthy volunteers. Participants to the 2016 International Hypnosis congress, Saint Malo, France were recruited in this prospective observational study. After comfortable positioning of the subject in the sitting position (T0), the hypnotic trance was induced (T1) then conducted with suggestions of comfort (T2) before return to normal consciousness (T3). The ANI, heart rate (HR) and respiratory rate (RR) were recorded at the different time-points. Forty subjects were enrolled (31 women, 9 men). The mean ± SD ANI at T2 (84 ± 12) was significantly greater than at T0 (60 ± 10), T1 (62 ± 9) and T3 (59 ± 11). The median [25th-75th percentile] ANI values at T2 were significantly greater in women (90 [83-95]) than in men (74 [68-83]). There were no significant variations of HR during time. The median [25th-75th percentile] RR at T1 (16 [14-18] breaths/min) and T2 (14 [12-16] breaths/min) were significantly smaller than at T0 (18 [16-20] breaths/min) and T3 (18 [16-20] breaths/min). This study shows that hypnosis induces an increase in the relative parasympathetic tone assessed by ANI in healthy volunteers, with greater ANI values observed in women. These results suggest that ANI monitoring may provide an objective tool for the measurement of the intensity of the hypnotic process, although this should be confirmed by further studies.
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28
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Wu G, Zhang L, Wang X, Yu A, Zhang Z, Yu J. Effects of indexes of consciousness (IoC1 and IoC2) monitoring on remifentanil dosage in modified radical mastectomy: a randomized trial. Trials 2016; 17:167. [PMID: 27026012 PMCID: PMC4810508 DOI: 10.1186/s13063-016-1298-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 03/17/2016] [Indexed: 11/24/2022] Open
Abstract
Background This study investigated the effects of indexes of consciousness (IoC1 and IoC2) monitoring on remifentanil dosage. Methods In this randomized, single-blinded, prospective study, 120 patients undergoing unilateral modified radical mastectomy were randomly assigned to the treatment group (T group, n = 60) or control group (C group, n = 60). In the T group, patients received both IoC1 (sedation) and IoC2 (analgesia) monitoring, and remifentanil dosages were adjusted by anesthetists according to IoC2. In the C group, remifentanil dosages were adjusted based on the anesthetists’ judgment according to the patients’ vital signs. Remifentanil dose, adjustment frequency, infusion duration, intraoperative adverse events, and quality of anesthetic recovery were compared between the two groups. The primary outcome was the dose of remifentanil. Results Compared with the C group, mean remifentanil dosage was significantly higher in the T group (3.8 ± 1.9 versus 3.2 ± 1.2 μg kg-1 h-1, P < 0.05) during the anesthetic period, as was the adjustment frequency of target-controlled infusion (2.9 ± 1.9 versus 2.0 ± 1.2 times/surgery, P < 0.05), but there was no difference in infusion duration. Voluntary eye opening, extubation time, and recovery score were not significantly different between the two groups (P > 0.05). Total adverse events were significantly reduced in the T group (P < 0.05). Conclusions IoC1-targeted propofol dosing does not seem to be significantly different to hemodynamic-based monitoring, whereas IoC2 monitoring can increase remifentanil dosage during modified radical mastectomy, but the anesthetic process is more controllable and total adverse events are reduced, which improves the controllability of anesthesia. Trial registration Trial registration number: ChiCTR-TRC-13004101, registered on 27 November 2013.
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Affiliation(s)
- Guisheng Wu
- Department of Anesthesiology, Qilu Hospital, Shandong University, Jinan, 250012, China.,Department of Anesthesiology, Liaocheng People's Hospital, Liaocheng, 252000, China
| | - Lei Zhang
- Department of Anesthesiology, Liaocheng People's Hospital, Liaocheng, 252000, China
| | - Xuxiang Wang
- Department of Anesthesiology, Liaocheng People's Hospital, Liaocheng, 252000, China
| | - Ailan Yu
- Department of Anesthesiology, Liaocheng People's Hospital, Liaocheng, 252000, China
| | - Zongwang Zhang
- Department of Anesthesiology, Liaocheng People's Hospital, Liaocheng, 252000, China
| | - Jingui Yu
- Department of Anesthesiology, Qilu Hospital, Shandong University, Jinan, 250012, China.
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29
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Boselli E, Logier R, Bouvet L, Allaouchiche B. Prediction of hemodynamic reactivity using dynamic variations of Analgesia/Nociception Index (∆ANI). J Clin Monit Comput 2015; 30:977-984. [PMID: 26546363 DOI: 10.1007/s10877-015-9802-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 11/01/2015] [Indexed: 11/30/2022]
Abstract
The Analgesia/Nociception Index (ANI), a 0-100 non-invasive index calculated from heart rate variability, reflects the analgesia/nociception balance during general anesthesia. We hypothesized that dynamic variations of ANI (∆ANI) would provide better performance than static values to predict hemodynamic reactivity during desflurane/remifentanil general anesthesia. One hundred and twenty-eight patients undergoing ear-nose-throat or lower limb orthopedic surgery were analyzed in this prospective observational study. The ANI, heart rate and systolic blood pressure were recorded before induction, at skin incision, during procedure and at emergence from general anesthesia. Changes in these variables were recorded after 1 min for ANI (ANI1min) and 5 min for heart rate and systolic blood pressure. The dynamic variation of ANI at the different time points was defined as: ∆ANI = (ANI1min - ANI)/([ANI + ANI1min]/2). Receiver-operating characteristic (ROC) curves were built to evaluate the performance of ANI, ANI1 min and ∆ANI to predict hemodynamic reactivity (increase by more than 20 % in heart rate and/or systolic blood pressure within 5 min). For the prediction of hemodynamic reactivity, better performance was observed with ∆ANI (area under ROC curve (AUC ROC) = 0.90) in comparison to ANI (ROC AUC = 0.50) and ANI1min (ROC AUC = 0.77). A ∆ANI threshold of -19 % predicts hemodynamic reactivity with 85 % [95 % CI 77-91] sensitivity and 85 % [95 % CI 81-89] specificity. Dynamic variations of ANI provide better performance than static values to predict hemodynamic reactivity during desflurane/remifentanil general anesthesia. These findings may be of interest for the individual adaptation of remifentanil doses guided by ∆ANI during general anesthesia, although this remains to be demonstrated.
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Affiliation(s)
- E Boselli
- Department of Anesthesiology and Intensive Care, Édouard Herriot Hospital, Service d'anesthésie-réanimation, Hospices Civils de Lyon, Claude Bernard Lyon I University, University of Lyon, 5 Place d'Arsonval, 69003, Lyon, France.
| | - R Logier
- CIC-IT INSERM 1403, University Hospital of Lille, Lille 2 University, Lille, France
| | - L Bouvet
- Department of Anesthesiology and Intensive Care, Édouard Herriot Hospital, Service d'anesthésie-réanimation, Hospices Civils de Lyon, Claude Bernard Lyon I University, University of Lyon, 5 Place d'Arsonval, 69003, Lyon, France
| | - B Allaouchiche
- Department of Anesthesiology and Intensive Care, Édouard Herriot Hospital, Service d'anesthésie-réanimation, Hospices Civils de Lyon, Claude Bernard Lyon I University, University of Lyon, 5 Place d'Arsonval, 69003, Lyon, France
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