Validation of the PMD100 and its NOL Index to detect nociception at different infusion regimen of remifentanil in patients under general anesthesia

Stöckle, Pierre-André; Julien, Marco; Issa, Rami; Décary, Elizabeth; Brulotte, Véronique; Drolet, Pierre; Henri, Margaret; Poirier, Madeleine; Latulippe, Jean-François; Dorais, Marc; Verdonck, Olivier; Fortier, Louis‐Philippe; Richebé, Philippe

doi:10.23736/s0375-9393.18.12720-9

Cited by 55 publications

(38 citation statements)

References 15 publications

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“…Study quality was evaluated with the Cochrane Collaboration's tool for assessing risk of bias in randomized trials [9]. This tool considers six domains of bias: (1) selection bias which includes the presence of random sequence generation and allocation concealment, (2) performance bias which includes the blinding of participants and personnel, (3) detection bias which includes the blinding of outcome assessment, (4) attrition bias, which includes incomplete outcome data, (5) reporting bias which includes selective reporting, and (6) other bias. For each study, the presence of bias in each domain was assessed independently by two reviewers (FM and MN).…”

Section: Bias Assessmentmentioning

confidence: 99%

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Does nociception monitor-guided anesthesia affect opioid consumption? A systematic review of randomized controlled trials

Meijer

Niesters

Velzen

et al. 2019

J Clin Monit Comput

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Monitors that estimate nociception during anesthesia may be used to guide opioid and other analgesics administration to optimize anesthesia care and possibly outcome. We reviewed the literature to evaluate current evidence of the effect of nociception-guided management over standard anesthesia practice during surgery. A systematic review of the literature on the effect of nociception monitoring on anesthesia practice was conducted. Reports were eligible if they compared nociception-guided anesthesia to standard practice during surgery. Primary endpoint of this review is intraoperative opioid consumption. Secondary endpoints included hemodynamic control, postoperative pain and pain treatment. We identified 12 randomized controlled trials that compared one of five different nociception monitoring techniques to standard anesthesia care. Most studies were single center studies of small sample size. Six studies reported intraoperative opioid consumption as primary outcome. There was considerable variability with respect to surgical procedure and anesthesia technique. For nociception monitors that were investigated by more than one study, analysis of the pooled data was performed. The surgical plethysmographic index was the only monitor for which an intra operative opioid sparing effect was found. For the other monitors, either no effect was detected, or pooled analysis could not be performed due to paucity of study data. On secondary outcomes, no consistent effect of nociception-guided anesthesia could be established. Although some nociception monitors show promising results, no definitive conclusions regarding the effect of nociception monitoring on intraoperative opioid consumption or other anesthesia related outcome can be drawn. Clinical trial number PROSPERO ID 102913.

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Section: Bias Assessmentmentioning

confidence: 99%

“…hypertension and hypotension), reliable nociception monitors may help optimize anesthetic management. Evidence from preclinical validation studies show that these monitors distinguish noxious and non-noxious events far better than hemodynamic responses [2][3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Does nociception monitor-guided anesthesia affect opioid consumption? A systematic review of randomized controlled trials

Meijer

Niesters

Velzen

et al. 2019

J Clin Monit Comput

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“…Wavelet index (WLI) is a sedation indicator monitoring the depth of anesthesia developed by the same company [18,19]. In previous studies, BIS has been used to monitor the hypnotic component of anesthesia and was confirmed to be unable to predict hemodynamic changes [5,26]. In our study, WLI decreased significantly faster than the PRI which represents the rapid hypnosis, and also failed in predicting hemodynamic responses.…”

Section: Discussionmentioning

confidence: 64%

“…The response to noxious stimulation during general anesthesia mainly depends on the balance between nociceptive and anti-nociceptive forces [1][2][3]. Nociception in anesthetized patients is typically demonstrated as sympathetic response to surgery and other noxious stimuli [4,5]. Excessive nociception not only affects the stability of hemodynamics, but may also exacerbate postoperative pain, disturb the balance of inflammation, and cause adverse outcomes [6,7].…”

Section: Introductionmentioning

confidence: 99%

Prediction of hemodynamic reactivity by electroencephalographically derived Pain Rating Index in children during general anesthesia: a prospective observational study

Wang²,

Wang

et al. 2019

Preprint

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Background: Pain rating index (PRI) is a novel measure of nociception based on integrated electroencephalogram parameters during general anesthesia. Wavelet index (WLI) as a sedation index reflects the patient's sedation state. This study aims to evaluate the performance of PRI and WLI to predict hemodynamic reactivity after tracheal intubation and skin incision in pediatric patients. Methods: 134 children undergoing elective general or urinary surgery were analyzed. PRI, WLI, heart rate (HR), and mean blood pressure (MBP) were measured at predefined time-points during tracheal intubation and skin incision. Receiver-operating characteristic (ROC) curves were computed to evaluate the predictive performance of PRI and WLI to measure hemodynamic reactivity (increase by more than 20% of either MBP or HR) during general anesthesia. Results: In 134 patients, positive reactivity of HR and MBP was observed in 95 (70.9%) and 61 (45.5%) patients induced by endotracheal intubation and 19 (14.2%) and 24 (17.9%) patients induced by skin incision. Using either HR or MBP reactivity induced by tracheal intubation as a dichotomous variable, the areas under the curves (AUCs) [95% CI] of PRI and WLI were 0.81[0.73-0.87] and 0.58[0.49-0.67] with the best cutoff values of 62 and 49; The AUCs [95% CI] of PRI and WLI were 0.82[0.75-0.88] and 0.61[0.52-0.69] after skin incision, the best cutoff values of PRI and WLI were 60 and 46, respectively. Conclusions: PRI can predict hemodynamic reactivity with the best cutoff values of 62 and 60 after tracheal intubation and skin incision in pediatric patients during general anesthesia while WLI failed in predicting hemodynamic changes. Trial registration: Chinese Clinical Trial Register (Unique identifier: ChiCTR1800015969, Date of registration: May 3, 2018). Key words: Pain Rating Index, Wavelet index, Hemodynamic reactivity, Pediatric patients

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“…in a prospective observational study, stokle et al tested the effectiveness of nociception level index (nol-index), a multidimensional index, to detect nociception during tetanic stimulation at various remifentanil concentrations in patients under general anesthesia. 28 the authors demonstrated that NOL monitoring reflected the degree of nociception better than single clinical parameters as the heart rate and the blood pressure and claimed for randomized studies to confirm their results. in an elegant rct, Park et al used the surgical Pleth index (sPi) to optimize analgesia during direct laryngoscopy; sPi proved to be a useful tool to evaluate the degree of analgesic protection against painful stimuli.…”

Section: Muscle Relaxantsmentioning

confidence: 99%

A year in review in Minerva Anestesiologica 2018

Cavaliere

Allegri²,

Apan

et al. 2019

Minerva Anestesiol

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Validation of the PMD100 and its NOL Index to detect nociception at different infusion regimen of remifentanil in patients under general anesthesia

Cited by 55 publications

References 15 publications

Does nociception monitor-guided anesthesia affect opioid consumption? A systematic review of randomized controlled trials

Does nociception monitor-guided anesthesia affect opioid consumption? A systematic review of randomized controlled trials

Prediction of hemodynamic reactivity by electroencephalographically derived Pain Rating Index in children during general anesthesia: a prospective observational study

A year in review in Minerva Anestesiologica 2018

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