PhysioDoloris: a monitoring device for Analgesia / Nociception balance evaluation using Heart Rate Variability analysis

Abstract

Continuous Analgesia / Nociception balance evaluation during general anesthesia could be of precious help for the optimization of analgesic drugs delivery, limiting the risk of toxicity due to the use of opioid drugs, limiting the risk of post operative hyper algesia, and, probably, reducing time of recovery after surgical procedure. Heart Rate Variability analysis has been shown in several studies to measure the Autonomic Nervous System tone, which is strongly influenced by anesthetic drugs. Recording RR series during general anesthesia enabled us to observe that the Respiratory Sinus Arrhythmia pattern changed when a surgical stimulation was painful, even though the patient was not conscious. We have previously developed and evaluated a pain / analgesia measurement algorithm based on the magnitude analysis of the respiratory patterns on the RR series. In this paper, we present the development of a monitoring device (PhysioDoloris), based on the previously described technology, giving in real time an Analgesia Nociception Index (ANI) which can be used during general anesthesia in order to give to the anesthetist, a complementary tool for optimized drug delivery.

Assessment of Nociceptive Responsiveness Levels during Sedation-Analgesia by Entropy Analysis of EEG

“…Several studies [36][37][38] relate nociception with the parameters derived from the analysis of heart rate variability (HRV). It has been demonstrated that the tone of the autonomic nervous system is strongly influenced by anesthetic drugs.…”

Prediction of Hemodynamic Reactivity during Sevoflurane Remifentanyl Anesthesia for Laparoscopic Cholecystectomy Using Analgesia Nociception Index

“…Son birkaç yılda, anestezinin dört temel öğesinden biri olan analjezi ve otonom reflekslerin, anestezistin deneyimi dışında objektif olarak değerlendirebilecek farklı parametreler üzerinde çalışılmıştır (24)(25). Bunlardan en önemlilerinden biri de çalışma grubumuzda kullandığımız ANİ'dir (8,9,26). KAH değişkenliğinden yararlanan bu indekste yeterli analjezi varlığında değişkenlik sadece solunumsal aritmiden kaynaklanır ve bu durum parasempatik tonus hakimiyetini gösterir.…”

“…Anestezi sırasında parasempatik otonom sinir sisteminin tonusunu ölçerek nosisepsiyon-analjezi dengesini ve dolayısıyla peroperatuvar dönemde analjezi yeterliliğini gösteren Analjezi Nosisepsiyon indeksi [ANİ, (Metrodolaris, Fransa)] yeni bir parametre olarak son yıllarda ortaya çıkmıştır (8,9). ANİ, kalp hızı varyasyonları içinde iki R dalgası arasındaki zaman aralığının solunum siklusu ile değişkenliğinin filtre edilerek ölçülmesi ve değerlendirilmesiyle elde edilen parasempatik tonusu (p∑) gösteren, 0-100 arasında değişen sayısal bir değerdir.…”

Closed-loop Administration of General Anaesthesia: From Sensor to Medical Device

“…The Analgesia Nociception Index (ANI) monitor (MDMS, Loos, France) enables a real time analysis of the pS activity based on the ECG signal [31], by detecting each R peak and establishing the RR interval series over time (Figure 2).…”