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
T2 - 3rd European Medical and Biological Engineering Conference, EMBEC'05
Y2 - 20 November 2005 through 25 November 2005
ER -