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

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
Volume11
ISSN1680-0737

Conference

Conference3rd European Medical and Biological Engineering Conference, EMBEC'05
Abbreviated titleEMBEC
CountryCzech Republic
CityPrague
Period20/11/0525/11/05

Fingerprint

Nociception
Photoplethysmography
Entropy
Propofol
Analgesia
Heart Rate
Skin
Pulse
Electroencephalography
Electrocardiography
remifentanil
Pharmaceutical Preparations

Keywords

  • analgesia
  • depth of anaesthesia
  • heart-rate variability

Cite this

van Gils, M., Korhonen, I., Huiku, M., Yppärilä-Wolters, H., Viertiö-Oja, H., Meriläinen, P., ... Yli-Hankala, A. (2005). Development of an index for assessment of nociception at incision during surgery. In Proceedings of the 3rd European Medical and Biological Engineering Conference, IFMBE Proceedings, 2005 [1529F] IFMBE Proceedings, Vol.. 11
van Gils, Mark ; Korhonen, Ilkka ; Huiku, M. ; Yppärilä-Wolters, Heidi ; Viertiö-Oja, H. ; Meriläinen, P. ; Kymäläinen, M. ; Takala, P. ; Uutela, K. ; Rantanen, M. ; Yli-Hankala, A. / Development of an index for assessment of nociception at incision during surgery. Proceedings of the 3rd European Medical and Biological Engineering Conference, IFMBE Proceedings, 2005. 2005. (IFMBE Proceedings, Vol. 11).
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title = "Development of an index for assessment of nociception at incision during surgery",
abstract = "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",
keywords = "analgesia, depth of anaesthesia, heart-rate variability",
author = "{van Gils}, Mark and Ilkka Korhonen and M. Huiku and Heidi Ypp{\"a}ril{\"a}-Wolters and H. Vierti{\"o}-Oja and P. Meril{\"a}inen and M. Kym{\"a}l{\"a}inen and P. Takala and K. Uutela and M. Rantanen and A. Yli-Hankala",
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language = "English",
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van Gils, M, Korhonen, I, Huiku, M, Yppärilä-Wolters, H, Viertiö-Oja, H, Meriläinen, P, Kymäläinen, M, Takala, P, Uutela, K, Rantanen, M & Yli-Hankala, A 2005, Development of an index for assessment of nociception at incision during surgery. in Proceedings of the 3rd European Medical and Biological Engineering Conference, IFMBE Proceedings, 2005., 1529F, IFMBE Proceedings, vol. 11, 3rd European Medical and Biological Engineering Conference, EMBEC'05, Prague, Czech Republic, 20/11/05.

Development of an index for assessment of nociception at incision during surgery. / van Gils, Mark; Korhonen, Ilkka; Huiku, M.; Yppärilä-Wolters, Heidi; Viertiö-Oja, H.; Meriläinen, P.; Kymäläinen, M.; Takala, P.; Uutela, K.; Rantanen, M.; Yli-Hankala, A.

Proceedings of the 3rd European Medical and Biological Engineering Conference, IFMBE Proceedings, 2005. 2005. 1529F (IFMBE Proceedings, Vol. 11).

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

TY - GEN

T1 - Development of an index for assessment of nociception at incision during surgery

AU - van Gils, Mark

AU - Korhonen, Ilkka

AU - Huiku, M.

AU - Yppärilä-Wolters, Heidi

AU - Viertiö-Oja, H.

AU - Meriläinen, P.

AU - Kymäläinen, M.

AU - Takala, P.

AU - Uutela, K.

AU - Rantanen, M.

AU - Yli-Hankala, A.

PY - 2005

Y1 - 2005

N2 - 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

AB - 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

KW - analgesia

KW - depth of anaesthesia

KW - heart-rate variability

M3 - Conference article in proceedings

T3 - IFMBE Proceedings

BT - Proceedings of the 3rd European Medical and Biological Engineering Conference, IFMBE Proceedings, 2005

ER -

van Gils M, Korhonen I, Huiku M, Yppärilä-Wolters H, Viertiö-Oja H, Meriläinen P et al. Development of an index for assessment of nociception at incision during surgery. In Proceedings of the 3rd European Medical and Biological Engineering Conference, IFMBE Proceedings, 2005. 2005. 1529F. (IFMBE Proceedings, Vol. 11).