Multiparametric Monitoring of Hypnosis and Nociception-Antinociception Balance during General Anesthesia—A New Era in Patient Safety Standards and Healthcare Management

Abstract

The development of general anesthesia techniques and anesthetic substances has opened new horizons for the expansion and improvement of surgical techniques. Nevertheless, more complex surgical procedures have brought a higher complexity and longer duration for general anesthesia, which has led to a series of adverse events such as hemodynamic instability, under- or overdosage of anesthetic drugs, and an increased number of post-anesthetic events. In order to adapt the anesthesia according to the particularities of each patient, the multimodal monitoring of these patients is highly recommended. Classically, general anesthesia monitoring consists of the analysis of vital functions and gas exchange. Multimodal monitoring refers to the concomitant monitoring of the degree of hypnosis and the nociceptive-antinociceptive balance. By titrating anesthetic drugs according to these parameters, clinical benefits can be obtained, such as hemodynamic stabilization, the reduction of awakening times, and the reduction of postoperative complications. Another important aspect is the impact on the status of inflammation and the redox balance. By minimizing inflammatory and oxidative impact, a faster recovery can be achieved that increases patient safety. The purpose of this literature review is to present the most modern multimodal monitoring techniques to discuss the particularities of each technique.

The Effects of Intraoperative Remifentanil Infusion on Postoperative Opioid Consumption in Patients Who Underwent Total Knee Arthroplasty with Femoral Nerve Block

“…Previous studies have shown that patients did not respond to intraoperative stimuli when qNOX levels were well controlled [19,20,28]. In a study of 60 patients who underwent general anesthesia with propofol and remifentanil, Jensen et al demonstrated that qNOX can detect subtle changes in nociceptive balance by showing a series of significant correlations.…”

“…All patients fasted from midnight and received glycopyrrolate 0.004 mg/kg via intramuscular injection and famotidine 20 mg intravenously before entering the operating room. After entering the operating room, the blood pressure, heart rate (HR), and qNOX [19,20] levels were measured to establish the baseline under standard monitoring. Both groups underwent an ultrasound-guided peripheral nerve block (PNB) before anesthesia.…”

Assessment and management of pain/nociception in patients with disorders of consciousness or locked-in syndrome: A narrative review

“…Its score ranges from 0 to 100, a low score meaning that the patient is able to process nociceptive stimulus. The Surgical Pleth Index (SPI) is rather based on the measurement of the orthosympathetic hemodynamic response to noxious stimulation, and uses normalized heartbeat intervals (HBIs) and plethysmography wave amplitude for its calculation ( Rogobete et al, 2021 ). The PDR and the GSR are also used in anesthesia to assess the sympathetic tone but have not yet been studied in detail in patients with DoC and LIS.…”

Developing a prediction model for estimating adrenocorticotropic hormone changes in patients undergoing scheduled open hepatectomy

“…Unlike other components of general anesthesia, such as hypnosis and muscle relaxation (1), currently, there is no gold standard for monitoring a patient's response to noxious stimuli during intraoperative analgesia (2). Due to the interpatient variability in response to nociceptive input, optimal opioid titration remains a challenge for anesthetists.…”