Increased variation of the response index of nociception during noxious stimulation in patients during general anaesthesia

Tia J.M. Sarén-Koivuniemi, Arvi M. Yli-Hankala, Mark van Gils (Corresponding Author)

Research output: Contribution to journalArticleScientificpeer-review

4 Citations (Scopus)

Abstract

Objective: Analgesia is an important part of general anaesthesia, but no direct indicators of nociceptive–anti-nociceptive balance have been validated in detail. The Response Index of Nociception (RN) is a multiparameter approach which combines photoplethysmographic waveform (PPG), State Entropy (SE), Response Entropy (RE), and heart rate variability (HRV). We aimed at evaluating RN during general anaesthesia; especially we wanted to compare pre- and post-index values of certain noxious stimuli to the average index values. Our assumption was that RN could be a useful indicator of nociceptive–anti-nociceptive balance during the surgery.

Methods: Sixty women undergoing gynaecological or breast surgery participated in the study. All patients had elective surgery and anaesthesia was maintained with propofol–remifentanil target controlled infusion. Neuromuscular blocking agent rocuronium was used at the beginning of the surgery. Electrocardiography (ECG), photoplethysmography (PPG) and electroencelophalography (EEG) were registered and extracted off-line. An index, reflecting amplitude and frequency of occurrence of abrupt increases (“peaks”) in the RN was evaluated during surgery in general and around occurrences of predefined noxious stimuli in particular.

Results: Fifty-four patients were eligible for analysis. Patient movement was associated with increased index values, both before and after the event. Post-event values of the index for intubation and skin incision were higher than its intra-surgery baseline, while pre-event values remained unchanged.

Conclusion: Changes in RN can be used to detect noxious stimuli during surgery. RN also predicted movement in our patients under propofol–remifentanil anaesthesia.
Original languageEnglish
Pages (from-to)154-160
JournalComputer Methods and Programs in Biomedicine
Volume104
Issue number2
DOIs
Publication statusPublished - 2011
MoE publication typeA1 Journal article-refereed
Event7th IFAC Symposium on Modelling and Control in Biomedical Systems - Aalborg, Denmark
Duration: 12 Aug 200914 Aug 2009

Fingerprint

Nociception
General Anesthesia
Surgery
Entropy
Anesthesia
Photoplethysmography
Neuromuscular Blocking Agents
Electrocardiography
Intubation
Analgesia
Skin
Breast
Heart Rate

Keywords

  • Nociception
  • monitoring
  • electroencephalography
  • entropy
  • photoplethysmography
  • movement
  • electrocardiograph

Cite this

@article{29944eaf177b4c788c345d430e79df75,
title = "Increased variation of the response index of nociception during noxious stimulation in patients during general anaesthesia",
abstract = "Objective: Analgesia is an important part of general anaesthesia, but no direct indicators of nociceptive–anti-nociceptive balance have been validated in detail. The Response Index of Nociception (RN) is a multiparameter approach which combines photoplethysmographic waveform (PPG), State Entropy (SE), Response Entropy (RE), and heart rate variability (HRV). We aimed at evaluating RN during general anaesthesia; especially we wanted to compare pre- and post-index values of certain noxious stimuli to the average index values. Our assumption was that RN could be a useful indicator of nociceptive–anti-nociceptive balance during the surgery.Methods: Sixty women undergoing gynaecological or breast surgery participated in the study. All patients had elective surgery and anaesthesia was maintained with propofol–remifentanil target controlled infusion. Neuromuscular blocking agent rocuronium was used at the beginning of the surgery. Electrocardiography (ECG), photoplethysmography (PPG) and electroencelophalography (EEG) were registered and extracted off-line. An index, reflecting amplitude and frequency of occurrence of abrupt increases (“peaks”) in the RN was evaluated during surgery in general and around occurrences of predefined noxious stimuli in particular.Results: Fifty-four patients were eligible for analysis. Patient movement was associated with increased index values, both before and after the event. Post-event values of the index for intubation and skin incision were higher than its intra-surgery baseline, while pre-event values remained unchanged.Conclusion: Changes in RN can be used to detect noxious stimuli during surgery. RN also predicted movement in our patients under propofol–remifentanil anaesthesia.",
keywords = "Nociception, monitoring, electroencephalography, entropy, photoplethysmography, movement, electrocardiograph",
author = "Sar{\'e}n-Koivuniemi, {Tia J.M.} and Yli-Hankala, {Arvi M.} and {van Gils}, Mark",
year = "2011",
doi = "10.1016/j.cmpb.2010.10.001",
language = "English",
volume = "104",
pages = "154--160",
journal = "Computer Methods and Programs in Biomedicine",
issn = "0169-2607",
publisher = "Elsevier",
number = "2",

}

Increased variation of the response index of nociception during noxious stimulation in patients during general anaesthesia. / Sarén-Koivuniemi, Tia J.M.; Yli-Hankala, Arvi M.; van Gils, Mark (Corresponding Author).

In: Computer Methods and Programs in Biomedicine, Vol. 104, No. 2, 2011, p. 154-160.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Increased variation of the response index of nociception during noxious stimulation in patients during general anaesthesia

AU - Sarén-Koivuniemi, Tia J.M.

AU - Yli-Hankala, Arvi M.

AU - van Gils, Mark

PY - 2011

Y1 - 2011

N2 - Objective: Analgesia is an important part of general anaesthesia, but no direct indicators of nociceptive–anti-nociceptive balance have been validated in detail. The Response Index of Nociception (RN) is a multiparameter approach which combines photoplethysmographic waveform (PPG), State Entropy (SE), Response Entropy (RE), and heart rate variability (HRV). We aimed at evaluating RN during general anaesthesia; especially we wanted to compare pre- and post-index values of certain noxious stimuli to the average index values. Our assumption was that RN could be a useful indicator of nociceptive–anti-nociceptive balance during the surgery.Methods: Sixty women undergoing gynaecological or breast surgery participated in the study. All patients had elective surgery and anaesthesia was maintained with propofol–remifentanil target controlled infusion. Neuromuscular blocking agent rocuronium was used at the beginning of the surgery. Electrocardiography (ECG), photoplethysmography (PPG) and electroencelophalography (EEG) were registered and extracted off-line. An index, reflecting amplitude and frequency of occurrence of abrupt increases (“peaks”) in the RN was evaluated during surgery in general and around occurrences of predefined noxious stimuli in particular.Results: Fifty-four patients were eligible for analysis. Patient movement was associated with increased index values, both before and after the event. Post-event values of the index for intubation and skin incision were higher than its intra-surgery baseline, while pre-event values remained unchanged.Conclusion: Changes in RN can be used to detect noxious stimuli during surgery. RN also predicted movement in our patients under propofol–remifentanil anaesthesia.

AB - Objective: Analgesia is an important part of general anaesthesia, but no direct indicators of nociceptive–anti-nociceptive balance have been validated in detail. The Response Index of Nociception (RN) is a multiparameter approach which combines photoplethysmographic waveform (PPG), State Entropy (SE), Response Entropy (RE), and heart rate variability (HRV). We aimed at evaluating RN during general anaesthesia; especially we wanted to compare pre- and post-index values of certain noxious stimuli to the average index values. Our assumption was that RN could be a useful indicator of nociceptive–anti-nociceptive balance during the surgery.Methods: Sixty women undergoing gynaecological or breast surgery participated in the study. All patients had elective surgery and anaesthesia was maintained with propofol–remifentanil target controlled infusion. Neuromuscular blocking agent rocuronium was used at the beginning of the surgery. Electrocardiography (ECG), photoplethysmography (PPG) and electroencelophalography (EEG) were registered and extracted off-line. An index, reflecting amplitude and frequency of occurrence of abrupt increases (“peaks”) in the RN was evaluated during surgery in general and around occurrences of predefined noxious stimuli in particular.Results: Fifty-four patients were eligible for analysis. Patient movement was associated with increased index values, both before and after the event. Post-event values of the index for intubation and skin incision were higher than its intra-surgery baseline, while pre-event values remained unchanged.Conclusion: Changes in RN can be used to detect noxious stimuli during surgery. RN also predicted movement in our patients under propofol–remifentanil anaesthesia.

KW - Nociception

KW - monitoring

KW - electroencephalography

KW - entropy

KW - photoplethysmography

KW - movement

KW - electrocardiograph

U2 - 10.1016/j.cmpb.2010.10.001

DO - 10.1016/j.cmpb.2010.10.001

M3 - Article

VL - 104

SP - 154

EP - 160

JO - Computer Methods and Programs in Biomedicine

JF - Computer Methods and Programs in Biomedicine

SN - 0169-2607

IS - 2

ER -