Pain management is a general concern for healthcare quality. In the particular context of neonatal care, it's well known that an efficient pain management will decrease mortality and morbidity of newborn infants. Furthermore, the plasticity of developing brain is vulnerable to pain and/or stress, that in turn may cause long term neurodevelopmental changes, including altered pain sensitivity and neuroanatomic and behavioural abnormalities. During neonatal intensive care stay, large number of painful procedures are performed, the majority of which are not accompanied by adequate analgesia. Optimal management requires competent pain assessment which can be especially difficult to perform in this non verbal population. We have developed an instantaneous heart rate variability (HRV) analysis method, non intrusive and user-friendly, based on the ECG signal acquisition. This analysis method enabled us to design parameters related to the influence of pain on the Autonomic Nervous System (ANS) activity. This paper presents the application of this method, previously validated for adults under general anesthesia, to the domain of newborn infants prolonged pain assessment.

Heart Rate Variability analysis has been shown in several studies to measure the Autonomic Nervous System tone, which is strongly influenced by pain, stress or anxiety. We have previously described and developed an Analgesia/Nociception Index for pain measurement during surgical procedure. This index based on a heart rate variability analysis can be considered as a vagal tone index and used in several other environments. In this paper, we present an adaptation of our technology for stress / anxiety evaluation in the particular domain of incident management teams training.

Pneumatic tourniquets are widely used to provide a bloodless operative field during upper or lower limb surgery. If tourniquet inflation during general anesthesia is initially a mild stimulus, a long duration of inflation can imply heart rate and blood pressure increasing. However, heart rate or blood pressure increasing can also be caused by other external stimuli. Indeed, in the case of an insufficient analgesia, painful surgical stimuli can also cause an increase in heart rate and blood pressure. Therefore, in the case of the use of a tourniquet during surgery, it's very difficult for the anesthesiologist to distinguish hypertension caused by pain from hypertension caused by tourniquet inflation. In such a case, an efficient and reliable hypertension diagnosis could help the anesthesiologist in the medication choice. We have previously developed and evaluated an Analgesia / Nociception Index (ANI) based on the magnitude analysis of the respiratory patterns on the RR series. We hypothesize that the use of such an index could help in the arterial hypertension etiological diagnosis during surgical procedures under tourniquet.

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