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Ionescu CM, Copot D, Yumuk E, De Keyser R, Muresan C, Birs IR, Ben Othman G, Farbakhsh H, Ynineb AR, Neckebroek M. Development, Validation, and Comparison of a Novel Nociception/Anti-Nociception Monitor against Two Commercial Monitors in General Anesthesia. Sensors (Basel) 2024; 24:2031. [PMID: 38610243 PMCID: PMC11013864 DOI: 10.3390/s24072031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/12/2024] [Accepted: 03/20/2024] [Indexed: 04/14/2024]
Abstract
In this paper, we present the development and the validation of a novel index of nociception/anti-nociception (N/AN) based on skin impedance measurement in time and frequency domain with our prototype AnspecPro device. The primary objective of the study was to compare the Anspec-PRO device with two other commercial devices (Medasense, Medstorm). This comparison was designed to be conducted under the same conditions for the three devices. This was carried out during total intravenous anesthesia (TIVA) by investigating its outcomes related to noxious stimulus. In a carefully designed clinical protocol during general anesthesia from induction until emergence, we extract data for estimating individualized causal dynamic models between drug infusion and their monitored effect variables. Specifically, these are Propofol hypnotic drug to Bispectral index of hypnosis level and Remifentanil opioid drug to each of the three aforementioned devices. When compared, statistical analysis of the regions before and during the standardized stimulus shows consistent difference between regions for all devices and for all indices. These results suggest that the proposed methodology for data extraction and processing for AnspecPro delivers the same information as the two commercial devices.
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Affiliation(s)
- Clara M. Ionescu
- Department of Electromechanics, System and Metal Engineering, Ghent University, 9052 Ghent, Belgium; (C.M.I.); (E.Y.); (R.D.K.); (I.R.B.); (G.B.O.); (H.F.); (A.R.Y.)
- Department of Automation, Technical University Cluj-Napoca, Memorandumului Street 20, 400114 Cluj, Romania;
| | - Dana Copot
- Department of Electromechanics, System and Metal Engineering, Ghent University, 9052 Ghent, Belgium; (C.M.I.); (E.Y.); (R.D.K.); (I.R.B.); (G.B.O.); (H.F.); (A.R.Y.)
| | - Erhan Yumuk
- Department of Electromechanics, System and Metal Engineering, Ghent University, 9052 Ghent, Belgium; (C.M.I.); (E.Y.); (R.D.K.); (I.R.B.); (G.B.O.); (H.F.); (A.R.Y.)
- Department of Control and Automation Engineering, Istanbul Technical University, Maslak, Istanbul 34469, Turkey
| | - Robin De Keyser
- Department of Electromechanics, System and Metal Engineering, Ghent University, 9052 Ghent, Belgium; (C.M.I.); (E.Y.); (R.D.K.); (I.R.B.); (G.B.O.); (H.F.); (A.R.Y.)
| | - Cristina Muresan
- Department of Automation, Technical University Cluj-Napoca, Memorandumului Street 20, 400114 Cluj, Romania;
| | - Isabela Roxana Birs
- Department of Electromechanics, System and Metal Engineering, Ghent University, 9052 Ghent, Belgium; (C.M.I.); (E.Y.); (R.D.K.); (I.R.B.); (G.B.O.); (H.F.); (A.R.Y.)
- Department of Automation, Technical University Cluj-Napoca, Memorandumului Street 20, 400114 Cluj, Romania;
| | - Ghada Ben Othman
- Department of Electromechanics, System and Metal Engineering, Ghent University, 9052 Ghent, Belgium; (C.M.I.); (E.Y.); (R.D.K.); (I.R.B.); (G.B.O.); (H.F.); (A.R.Y.)
| | - Hamed Farbakhsh
- Department of Electromechanics, System and Metal Engineering, Ghent University, 9052 Ghent, Belgium; (C.M.I.); (E.Y.); (R.D.K.); (I.R.B.); (G.B.O.); (H.F.); (A.R.Y.)
| | - Amani R. Ynineb
- Department of Electromechanics, System and Metal Engineering, Ghent University, 9052 Ghent, Belgium; (C.M.I.); (E.Y.); (R.D.K.); (I.R.B.); (G.B.O.); (H.F.); (A.R.Y.)
| | - Martine Neckebroek
- Department of Anesthesia, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium;
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Bertolizio G, Garbin M, Ingelmo PM. Evaluation of Nociception during Pediatric Surgery: A Topical Review. J Pers Med 2023; 13:260. [PMID: 36836492 PMCID: PMC9964458 DOI: 10.3390/jpm13020260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 01/26/2023] [Accepted: 01/26/2023] [Indexed: 02/03/2023] Open
Abstract
The association between intraoperative nociception and increased patient's morbidity is well established. However, hemodynamic parameters, such as heart rate and blood pressure, may result in an inadequate monitor of nociception during surgery. Over the last two decades, different devices have been marketed to "reliably" detect intraoperative nociception. Since the direct measure of nociception is impractical during surgery, these monitors measures nociception surrogates such as sympathetic and parasympathetic nervous systems responses (heart rate variability, pupillometry, skin conductance), electroencephalographic changes, and muscular reflex arc. Each monitor carries its own advantages and disadvantages. The manuscript aims to give an overview of the most up-to-date information available in the literature on current nociceptor monitors available in clinical practice, with particular focus on their applications in pediatrics.
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Affiliation(s)
- Gianluca Bertolizio
- Department of Pediatric Anesthesiology, Montreal Children’s Hospital, Montreal, QC H4A 3J1, Canada
- Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H4A 3J1, Canada
- Research Institute, McGill University Health Center, Montreal, QC H4A 3J1, Canada
| | - Marta Garbin
- Department of Clinical Sciences, Université de Montréal, St-Hyacinthe, QC J2S 2M2, Canada
| | - Pablo M. Ingelmo
- Department of Pediatric Anesthesiology, Montreal Children’s Hospital, Montreal, QC H4A 3J1, Canada
- Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H4A 3J1, Canada
- Research Institute, McGill University Health Center, Montreal, QC H4A 3J1, Canada
- Edwards Family Interdisciplinary Center for Complex Pain, Montreal Children’s Hospital, Montreal, QC H4A 3J1, Canada
- Alan Edwards Center for Research on Pain, McGill University, Montreal, QC H3A 2B4, Canada
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Wang X, Zhang J, Feng K, Yang Y, Qi W, Martinez-Vazquez P, Zhao G, Wang T. The effect of hypothermia during cardiopulmonary bypass on three electro-encephalographic indices assessing analgesia and hypnosis during anesthesia: consciousness index, nociception index, and bispectral index. Perfusion 2019; 35:154-162. [PMID: 31387454 DOI: 10.1177/0267659119864821] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The depth of anesthesia is commonly assessed in clinical practice by the patient's clinical signs. However, during cardiopulmonary bypass and hypothermia, common symptoms of nociception such as tachycardia, hypertension, sweating, or movement have low sensitivity and specificity in the description of the patient nociception and hypnosis, in particular, detecting nociceptive stimuli. Better monitoring of the depth of analgesia during hypothermia under cardiopulmonary bypass will avoid underdosage or overdosage of analgesia, especially opioids. Induced hypothermia has a multifactorial effect on the level of analgesia and hypnosis. Thermoregulatory processes appear essential for the activation of analgesic mechanisms, ranging from a physiological strong negative affiliation between nerve conduction velocity and temperature, until significant repercussions on the pharmacological dynamics of the analgesic drugs, the latter decreasing the clearance rate with a subsequent increase in the effect-site concentrations. Under the hypothesis that deep hypothermia induces massive effects on the analgesia and hypnosis levels of the patient, we studied whether hypothermia effects were mirrored by several neuromonitoring indices: two hypnosis indices, consciousness index and bispectral index, and a novel nociception index designed to evaluate the analgesic depth. In this clinical trial, 39 patients were monitored during general anesthesia with coronary atherosclerosis cardiopathy who were elective for on-pump coronary artery bypass graft surgery under hypothermia. The changes and correlation between the consciousness index, bispectral index, and nociception index with respect to the temperature were compared in different timepoints at basic state, during cardiopulmonary bypass and after cardiopulmonary bypass. While the three neuromonitoring indices showed significant correlations with respect to the temperature, the nociception index and consciousness index showed the strongest sensitivities, indicating that these two indices could be an important means of intraoperative neuromonitoring during induced hypothermia under cardiopulmonary bypass.
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Affiliation(s)
- Xiaohua Wang
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China.,National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jinfeng Zhang
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China.,National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Kunpeng Feng
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China.,National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yu Yang
- Department of Cardiac surgery, Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wenwei Qi
- Department of Medical Informatics, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Pablo Martinez-Vazquez
- Department of Medical Informatics, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Guoguang Zhao
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China.,National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tianlong Wang
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China.,National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital, Capital Medical University, Beijing, China
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Ledowski T. Objective monitoring of nociception: a review of current commercial solutions. Br J Anaesth 2019; 123:e312-21. [PMID: 31047645 DOI: 10.1016/j.bja.2019.03.024] [Citation(s) in RCA: 126] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 02/11/2019] [Accepted: 03/04/2019] [Indexed: 11/22/2022] Open
Abstract
Nociception, in contrast to pain, is not a subjective feeling, but the physiological encoding and processing of nociceptive stimuli. However, monitoring nociception remains a challenge in attempts to lower the incidence of acute postoperative pain and the move towards a more automated approach to analgesia and anaesthesia. To date, several commercialised devices promise a more accurate reflection of nociception than the traditionally used vital signs, blood pressure and heart rate. This narrative review presents an overview of existing technologies and commercially available devices, and offers a perspective for future research. Although firm conclusions about individual methods may be premature, none currently appears to offer a sufficiently broad applicability. Furthermore, there is currently no firm evidence for any clinically relevant influence of such devices on patient outcome. However, the available monitors have significantly aided the understanding of underlying mechanisms and identification of potential pitfalls.
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