Introduction: Analgesia Nociception Index (ANI) as a monitor of peri-operative nociception-antinociception balance has not been studied in paediatric neurosurgery. The objectives were to study the correlation between ANI (Mdoloris Education system) and revised-FLACC (r-FLACC) score for the prediction of acute postoperative pain in paediatric population undergoing elective craniotomies and to compare the changes in ANI values with Heart Rate (HR), Mean arterial pressure (MAP), and Surgical Plethysmographic Index (SPI) during various time points of intraoperative noxious stimulation and before and after opioid administration. Methods: This prospective observational pilot study included 14 patients between 2-12 years of age undergoing elective craniotomies. HR, MAP, SPI, ANI instantaneous (ANIi) and ANI mean (ANIm) values were recorded intra-operatively, and before and after opioid administration. Post-operatively HR, MAP, ANIi and ANIm, and pain scores (r-FLACC scale) were recorded. Results: There was a statistically significant negative correlation between ANIi and ANIm with r-FLACC during the time course of PACU stay (r= -0.89, P < 0.001 and r= -0.88 and P< 0.001 respectively)). Intra-operatively, in patients with ANIi values <50, with additional fentanyl administration, there was an increasing trend in values beyond 50, which was statistically significant (p<0.05) at 3,4,5 and 10 minutes. The trend in changes of SPI after opioid administration was not found to be significant for patients irrespective of the baseline SPI values. Conclusion: The ANI is a reliable tool for objective assessment of acute post-operative pain as assessed by r-FLACC in children undergoing craniotomies for intracranial lesions. It may be used as a guide to nociception-antinociception balance during the peri-operative period in this population.

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Introduction:Analgesia Nociception Index (ANI) as a monitor of peri-operative nociception-antinociception balance has not been studied in paediatric neurosurgery. The objectives were to study the correlation between ANI (Mdoloris Education system) and revised-FLACC (r-FLACC) score for the prediction of acute postoperative pain in paediatric population undergoing elective craniotomies and to compare the changes in ANI values with Heart Rate (HR), Mean arterial pressure (MAP), and Surgical Plethysmographic Index (SPI) during various time points of intraoperative noxious stimulation and before and after opioid administration. Methods:This prospective observational pilot study included 14 patients between 2-12 years of age undergoing elective craniotomies. HR, MAP, SPI, ANI instantaneous (ANIi) and ANI mean (ANIm) values were recorded intra-operatively, and before and after opioid administration. Post-operatively HR, MAP, ANIi and ANIm, and pain scores (r-FLACC scale) were recorded. Results:There was a statistically signi cant negative correlation between ANIi and ANIm with r-FLACC during the time course of PACU stay (r= -0.89, P < 0.001 and r= -0.88 and P< 0.001 respectively)). Intra-operatively, in patients with ANIi values <50, with additional fentanyl administration, there was an increasing trend in values beyond 50, which was statistically signi cant (p<0.05) at 3,4,5 and 10 minutes. The trend in changes of SPI after opioid administration was not found to be signi cant for patients irrespective of the baseline SPI values. Conclusion:The ANI is a reliable tool for objective assessment of acute post-operative pain as assessed by r-FLACC in children undergoing craniotomies for intracranial lesions. It may be used as a guide to nociceptionantinociception balance during the peri-operative period in this population.

Background: Magnetic resonance imaging (MRI) under sedation requires faster recovery for early discharge and feeding resumption in children with neuropsychiatric disorders. The use of dexmedetomidine alone results in delayed recovery. Propofol, when used alone, can cause hypotension and respiratory depression. A new regimen for sedation was evaluated by exploiting the properties of these drugs, to allow faster recovery with minimal adverse events. Materials and Methods: One hundred and fifty children aged 2–12 years requiring MRI were randomly allocated to these three groups. Group P ( n = 50) received propofol bolus at 2 mg.kg −1 over 10 min followed by infusion at 100 μg.kg −1 .min −1 . Group D ( n = 50) received dexmedetomidine bolus of 2 μg.kg −1 over 10 min followed by infusion at 1 μg.kg −1 .h −1 . Group PD ( n = 50) received propofol bolus at 2 mg.kg −1 over 10 min followed by dexmedetomidine infusion at 1 μg.kg −1 .h −1 . Recovery characteristics were noted. Results: Recovery following sedation in Group PD (15 ± 7.0 min) and Group P (17.35 ± 7.4 min) were comparable and significantly ( P = 0.03) lesser than Group D (27.58 ± 8.09 min). Emergence delirium scores were significantly less in Group PD (5 ± 1.08) and Group D (5.6 ± 2.4), unlike scores in Group P (9 ± 2.43). About 79.5% (39/49) of children in Group P, 88.2% (45/51) of children in Group D, and 86% (43/50) of children in Group PD completed MRI without any movement. Seven (14.58%) in Group P, 2 (4%) in Group D, and 5 (10.20%) in Group PD required rescue sedation. Conclusion: The regimen with propofol bolus and dexmedetomidine infusion provided adequate sedation and better recovery characteristics in children aged 2–12 years without systemic complications, as compared to the use of either agent alone.