The predictive value of the heart rate variability‐derived Analgesia Nociception Index in children anaesthetized with sevoflurane: An observational pilot study

Weber, Frank; Geerts, N.J.E.; Roeleveld, H.G.; Warmenhoven, Annejet T; Liebrand, C.A.

doi:10.1002/ejp.1242

Cited by 18 publications

(11 citation statements)

References 9 publications

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“…Recent studies performed in anesthetized children suggest that the heart rate variability analysis derived Analgesia Nociception Index (ANI™; Mdoloris Medical Systems, Loos, France) may provide a more sensitive assessment of the nociception/antinociception balance than hemodynamic parameters . These pediatric studies are in accordance with the results of studies investigating the performance of the ANI in anesthetized adult patients …”

Section: Introductionsupporting

confidence: 65%

“…This and other findings can easily be compared to the results of our recent pediatric study with the ANI monitor, using exactly the same study design in patients aged between 2 and 12 years. ANI values <50 before opioid drug administration showed a significantly higher increase in approximately 10 units within 120 seconds, travelling across the 50 units border …”

Section: Discussionmentioning

confidence: 91%

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The heart rate variability‐derived Newborn Infant Parasympathetic Evaluation (NIPE™) Index in pediatric surgical patients from 0 to 2 years under sevoflurane anesthesia—A prospective observational pilot study

Weber

Roeleveld

Warmenhoven

et al. 2019

Pediatric Anesthesia

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BackgroundThe heart rate variability‐derived Newborn Infant Parasympathetic Evaluation (NIPE™) Index is a continuous noninvasive tool to assess pain and discomfort in infants <2 years. Initial studies focused on pain monitoring in the neonatal intensive care unit environment.AimsThe aim of this study was to investigate the performance of the NIPE in infants under sevoflurane anesthesia. The primary objective of this study was to compare the NIPE and heart rate as tools to help recognize the need for additional opioid drugs. Secondary objectives were the course of the NIPE and heart rate around specific standardized noxious procedural mile‐stones.MethodsNIPE and heart rate values recorded during a 120 seconds interval before the anesthetist's decision to administer additional opioid due to the perceived insufficient antinociception and during a 120 seconds interval after drug administration were analyzed by means of a repeated measures ANOVA. The same analyses were performed for datasets around per protocol administration of morphine for postoperative analgesia, performance of a caudal block and surgical incision.ResultsIn patients with a NIPE value <50, an additional opioid drug administration resulted in a rise of NIPE values, reaching a maximum increase of 5.1 (95% CI: 0.22‐9.99) units 120 seconds after drug administration (P = 0.041). There was no evidence of a change in heart rate during these two 120 seconds periods. Per protocol administration of morphine, caudal block, and surgical incision did not result in changes of the NIPE, which was around 65 units on these occasions, and heart rate.ConclusionIn infants anesthetized with sevoflurane, NIPE values <50 might be indicative of insufficient antinociception. The results of this observational pilot study might suggest that the NIPE could be a better measure of the nociception/antinociception balance than heart rate.

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Section: Introductionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 91%

The heart rate variability‐derived Newborn Infant Parasympathetic Evaluation (NIPE™) Index in pediatric surgical patients from 0 to 2 years under sevoflurane anesthesia—A prospective observational pilot study

Weber

Roeleveld

Warmenhoven

et al. 2019

Pediatric Anesthesia

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“…31 A second study evaluating the score in the setting of paediatric anaesthesia found that ANI correlated better with a perceived (attending anaesthetist) lack of analgesia and the reestablishment of sufficient analgesia than HR. 32 In an investigation of the predictive value of ANI monitoring at the end of surgery, Boselli and colleagues 33 found that an ANI >50 had a high (92% for ANI >50) NPV for moderate-tosevere postoperative pain. However, to date, this study remains the only associated publication, and prospective validation of these results is required.…”

Section: Single-parameter Scoresmentioning

confidence: 99%

Objective monitoring of nociception: a review of current commercial solutions

Ledowski

2019

British Journal of Anaesthesia

193

141

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Nociception, in contrast to pain, is not a subjective feeling, but the physiological encoding and processing of nociceptive stimuli. However, monitoring nociception remains a challenge in attempts to lower the incidence of acute postoperative pain and the move towards a more automated approach to analgesia and anaesthesia. To date, several commercialised devices promise a more accurate reflection of nociception than the traditionally used vital signs, blood pressure and heart rate. This narrative review presents an overview of existing technologies and commercially available devices, and offers a perspective for future research. Although firm conclusions about individual methods may be premature, none currently appears to offer a sufficiently broad applicability. Furthermore, there is currently no firm evidence for any clinically relevant influence of such devices on patient outcome. However, the available monitors have significantly aided the understanding of underlying mechanisms and identification of potential pitfalls.

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“…They found the Analgesia Nociception Index (ANI) more sensitive than pulse rate and mean blood pressure in detecting surgical noxious stimuli [34]. Also, Weber et al suggested monitoring devices using other parameters, such as skin conductance, plethysmography, pupillometry and heart rate variability were more sensitive assessment of the nociception/ antinociception balance than haemodynamic parameters [35].…”

Section: Case Nomentioning

confidence: 99%

Erector spinae plane block combined with general anaesthesia versus conventional general anaesthesia in lumbar spine surgery

Siam

Aliaa

El-Medany

et al. 2020

Egyptian Journal of Anaesthesia

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Background: Perioperative pain management should be planned preoperatively and based on usage of pharmacological and non-pharmacological modalities as a multimodal analgesia (MMA). Regional anaesthesia has superior advantages than opioid-based anaesthesia and is one of the cornerstones of the Enhanced Recovery After Surgery (ERAS) especially in Patients undergoing spine surgery having already troublesome chronic pain and analgesic use. The present study was carried out to compare erector spinae plane block (ESP) with general anaesthesia versus conventional general anaesthesia in lumbar spine surgery. Materials and Methods: This study was done on thirty adult patients of both sexes scheduled for elective lumbar spine surgery under general anaesthesia. They were randomly categorized into two equal groups (fifteen patients each); ESP was used for group I, and MMA was used for group II. Data was collected on anaesthetic requirements based on entropy monitoring and haemodynamic parameters, stress response measurement based on serum cortisol and blood glucose levels, controlled hypotensive anaesthesia; various drugs required and doses given, intraoperative and postoperative analgesia, postanaesthesia care unit data concerning recovery. Results: The group I (ESP) had statistically significant decrease of the response and the response-state entropy difference levels when compared to the group II (MMA) after stimulus and during the 1st time interval. The incidence of hemodynamic changes was significantly higher in the group I (ESP) than group II (MMA). Only the serum cortisol but not the blood glucose levels had statistically significant lower mean values 4 h postoperatively in group I (ESP) compared to group II (MMA). The patients received ESP had statistically significant lower mean expired isoflurane concentration, decreased emergence time, intraoperative fentanyl consumption and total dose of pethidine given up to 8 hrpostoperatively. Conclusions: Erector spinae plane block (ESP) can be considered safe and effective perioperative analgesic modality for lumbar spine simple decompression surgery. It helps in controlled hypotensive anaesthetic technique and decreases inhalational anaesthetics and intraoperative opioid requirements.

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The predictive value of the heart rate variability‐derived Analgesia Nociception Index in children anaesthetized with sevoflurane: An observational pilot study

Cited by 18 publications

References 9 publications

The heart rate variability‐derived Newborn Infant Parasympathetic Evaluation (NIPE™) Index in pediatric surgical patients from 0 to 2 years under sevoflurane anesthesia—A prospective observational pilot study

The heart rate variability‐derived Newborn Infant Parasympathetic Evaluation (NIPE™) Index in pediatric surgical patients from 0 to 2 years under sevoflurane anesthesia—A prospective observational pilot study

Objective monitoring of nociception: a review of current commercial solutions

Erector spinae plane block combined with general anaesthesia versus conventional general anaesthesia in lumbar spine surgery

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