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      Nociception-guided versus Standard Care during Remifentanil–Propofol Anesthesia : A Randomized Controlled Trial

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          Abstract

          The multidimensional index of nociception, the nociception level, outperforms blood pressure and heart rate in detection of nociceptive events during anesthesia. We hypothesized that nociception level-guided analgesia reduces opioid consumption and suboptimal anesthesia events such as low blood pressure and use of vasoactive medication.

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          Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery: toward an empirical definition of hypotension.

          Michael Walsh, Philip Devereaux, Amit X Garg … (2013)
          Intraoperative hypotension may contribute to postoperative acute kidney injury (AKI) and myocardial injury, but what blood pressures are unsafe is unclear. The authors evaluated the association between the intraoperative mean arterial pressure (MAP) and the risk of AKI and myocardial injury.
          Article 0 comments Cited 365 times – based on 0 reviews     Review now
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            PHARMACOKINETIC MODEL DRIVEN INFUSION OF PROPOFOL IN CHILDREN

            B. Marsh, M. White, N. Morton … (1991)
            Article 0 comments Cited 67 times – based on 0 reviews     Review now
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              Monitoring the nociception level: a multi-parameter approach.

              Mark Kliger, Nir Ben-Israel, Galit Zuckerman … (2013)
              The aim of the present study was to develop and validate an objective index for nociception level (NoL) of patients under general anesthesia, based on a combination of multiple physiological parameters. Twenty-five patients scheduled for elective surgery were enrolled. For clinical reference of NoL, the combined index of stimulus and analgesia was defined as a composite of the surgical stimulus level and a scaled effect-site concentration of opioid. The physiological parameters heart rate, heart rate variability (0.15-0.4 Hz band power), plethysmograph wave amplitude, skin conductance level, number of skin conductance fluctuations, and their time derivatives, were extracted. Two techniques to incorporate these parameters into a single index representing the NoL have been proposed: NoLlinear, based on an ordinary linear regression, and NoLnon-linear, based on a non-linear Random Forest regression. NoLlinear and NoLnon-linear significantly increased after moderate to severe noxious stimuli (Wilcoxon rank test, p < 0.01), while the individual parameters only partially responded. Receiver operating curve analysis showed that NoL index based on both techniques better discriminated noxious and non-noxious surgical events [area under curve (AUC) = 0.97] compared with individual parameters (AUC = 0.56-0.74). NoLnon-linear better ranked the level of nociception compared with NoLlinear (R = 0.88 vs. 0.77, p < 0.01). These results demonstrate the superiority of multi-parametric approach over any individual parameter in the evaluation of nociceptive response. In addition, advanced non-linear technique may have an advantage over ordinary linear regression for computing NoL index. Further research will define the usability of the NoL index as a clinical tool to assess the level of nociception during general anesthesia.
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                Author and article information

                Journal
                Title: Anesthesiology
                Abbreviated Title: Anesthesiology
                Publisher: Ovid Technologies (Wolters Kluwer Health)
                ISSN (Print): 0003-3022
                Publication date Created: 2019
                Publication date (Print): May 2019
                Volume: 130
                Issue: 5
                Pages: 745-755
                Article
                DOI: 10.1097/ALN.0000000000002634
                PubMed ID: 30829658
                SO-VID: f0293392-e41f-4c00-8845-c75d9aafa303
                Copyright © © 2019
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