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      Intraoperative “Analgesia Nociception Index”–Guided Fentanyl Administration During Sevoflurane Anesthesia in Lumbar Discectomy and Laminectomy : A Randomized Clinical Trial

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          Abstract

          The "Analgesia Nociception Index" (ANI; MetroDoloris Medical Systems, Lille, France) is a proposed noninvasive guide to analgesia derived from an electrocardiogram trace. ANI is scaled from 0 to 100; with previous studies suggesting that values ≥50 can indicate adequate analgesia. This clinical trial was designed to investigate the effect of intraoperative ANI-guided fentanyl administration on postoperative pain, under anesthetic conditions optimized for ANI functioning.

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          Predictors of postoperative pain and analgesic consumption: a qualitative systematic review.

          Hui Yun Vivian Ip, Amir Abrishami, Philip W H Peng … (2009)
          Pain is a subjective and multidimensional experience that is often inadequately managed in clinical practice. Effective control of postoperative pain is important after anesthesia and surgery. A systematic review was conducted to identify the independent predictive factors for postoperative pain and analgesic consumption. The authors identified 48 eligible studies with 23,037 patients included in the final analysis. Preoperative pain, anxiety, age, and type of surgery were four significant predictors for postoperative pain. Type of surgery, age, and psychological distress were the significant predictors for analgesic consumption. Gender was not found to be a consistent predictor as traditionally believed. Early identification of the predictors in patients at risk of postoperative pain will allow more effective intervention and better management. The coefficient of determination of the predictive models was less than 54%. More vigorous studies with robust statistics and validated designs are needed to investigate this field of interest.
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            Chronic Pain as an Outcome of Surgery

            Frederick Perkins, Henrik Kehlet (2000)
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              Age, minimum alveolar anesthetic concentration, and minimum alveolar anesthetic concentration-awake.

              E I Eger (2001)
              Two defining effects of inhaled anesthetics (immobility in the face of noxious stimulation, and absence of memory) correlate with the end-tidal concentrations of the anesthetics. Such defining effects are characterized as MAC (the concentration producing immobility in 50% of patients subjected to a noxious stimulus) and MAC-Awake (the concentration suppressing appropriate response to command in 50% of patients; memory is usually lost at MAC-Awake). If the concentrations are monitored and corrected for the effects of age and temperature, the concentrations may be displayed as multiples of MAC for a standard age, usually 40 yr. This article provides an algorithm that might be used to produce such a display, including provision of an estimate of the effect of nitrous oxide. Two defining effects of inhaled anesthetics (immobility in the face of noxious stimulation, and absence of memory) correlate with the end-tidal concentrations of the anesthetics. Thus, these defining effects may be monitored and the results displayed if the concentrations are known and corrected for the effects of age and temperature.
              Article 0 comments Cited 56 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Title: Anesthesia & Analgesia
                Abbreviated Title: Anesthesia & Analgesia
                Publisher: Ovid Technologies (Wolters Kluwer Health)
                ISSN (Print): 0003-2999
                Publication date Created: 2017
                Publication date (Print): July 2017
                Volume: 125
                Issue: 1
                Pages: 81-90
                Article
                DOI: 10.1213/ANE.0000000000001984
                PubMed ID: 28598927
                SO-VID: 714b70c6-a0d4-46b6-9792-0f4d46b0539a
                Copyright © © 2017
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