Development of an index for assessment of nociception at incision during surgery

Mark van Gils, Ilkka Korhonen, M. Huiku, Heidi Yppärilä-Wolters, H. Viertiö-Oja, P. Meriläinen, M. Kymäläinen, P. Takala, K. Uutela, M. Rantanen, A. Yli-Hankala

Research output: Chapter in Book/Report/Conference proceedingConference article in proceedingsScientificpeer-review


Abstract: Currently no objective direct indicator for nociception in anaesthetised patients exists. We aimed to find an indicator by combining physiological parameters obtained at the moment of skin incision during surgery. 55 females were anaesthetised with propofol-remifentanil target controlled infusions. Propofol was given to maintain a State Entropy of 50. Remifentanil target was randomised to 1, 3, or 5 ng/ml. Electrocardiogram, photoplethysmography (PPG), and EEG spectral entropy were recorded and analysed off-line, starting 60 s before and lasting until 120 s after skin incision. Patient reactions were annotated. Heart rate variability (HRV), PPG signal, and pulse transition time (PTT) related features were derived. Clinical signs, remifentanil levels and estimated intensity of incision were combined into a clinical score (CSSA) associated with probability of nociception. Physiological features were analysed to find a predictor (RN) of CSSA. This was achieved by combining features from HRV, spectral entropy, and PPG. The prediction-probabilty (Pk) of CSSA estimation was 0.74. RN was higher after larger incision (P=0.04), in movers (P=0.02), and in patients with lower remifentanil concentrations (P=0.00001). Concluding, RN seems to adequately monitor the components of analgesia: intensity of noxious stimulus and drug effect, and be related to clinical signs of inadequate analgesia
Original languageEnglish
Title of host publicationProceedings of the 3rd European Medical and Biological Engineering Conference, IFMBE Proceedings, 2005
Publication statusPublished - 2005
MoE publication typeA4 Article in a conference publication
Event3rd European Medical and Biological Engineering Conference, EMBEC'05 - Prague, Czech Republic
Duration: 20 Nov 200525 Nov 2005

Publication series

SeriesIFMBE Proceedings


Conference3rd European Medical and Biological Engineering Conference, EMBEC'05
Abbreviated titleEMBEC
CountryCzech Republic


  • analgesia
  • depth of anaesthesia
  • heart-rate variability

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