Novel multiparameter approach for measurement of nociception at skin incision during general anaesthesia

M. Rantanen, A. Yli-Hankala (Corresponding Author), Mark van Gils, Heidi Yppärilä-Wolters, P. Takala, M. Huiku, M. Kymäläinen, E. Seitsonen, Ilkka Korhonen

Research output: Contribution to journalArticleScientificpeer-review

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Abstract

Background: Direct indicators for the evaluation of the nociceptive–anti-nociceptive balance during general anaesthesia do not exist. The aim of this study was to combine physiological parameters to obtain such an indicator.

Methods: Fifty-five females scheduled for surgery under general anaesthesia combining target-controlled infusions of propofol and remifentanil were studied. Propofol was given to maintain state entropy (SE) at 50 and remifentanil was targeted at 1, 3 or 5 ng ml−1. The patients’ reactions and clinical signs of nociception, remifentanil levels and estimation of noxious intensity of incision were combined into a clinical score [Clinical Signs–Stimulus–Antinociception (CSSA)] to evaluate the nociceptive–anti-nociceptive balance. ECG, photoplethysmography (PPG), response entropy (RE) and SE were recorded from 60 s before to 120 s after skin incision. Differences between post- and pre-incision values of heart rate variability (HRV), PPG and pulse transition time related parameters were analysed off-line to evidence the best predictors of CSSA. Those best predictors of CSSA served to develop a response index of nociception (RN), scaled from 0 to 100. This index was further tested in 10 additional patients.

Results: HRV, RE, RE–SE and PPG variability were the best predictors of CSSA. The prediction probability of RN at predicting CSSA was 0.78. RN response was higher after larger incision, in movers and with lower remifentanil concentrations.

Conclusions: The empirically developed algorithm of RN leads to an index that seems to adequately estimate the nociceptive–anti-nociceptive balance at skin incision during general anaesthesia. In the future, CSSA may serve as a reference for studies investigating methods aimed at evaluating this pharmacodynamic component of anaesthesia.
Original languageEnglish
Pages (from-to)367-376
JournalBritish Journal of Anaesthesia
Volume96
Issue number3
DOIs
Publication statusPublished - 2006
MoE publication typeA1 Journal article-refereed

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Nociception
General Anesthesia
Photoplethysmography
Entropy
Skin
Propofol
Heart Rate
Pulse
Electrocardiography
Anesthesia
remifentanil

Keywords

  • anaesthesia
  • depth of anaesthesia

Cite this

Rantanen, M., Yli-Hankala, A., van Gils, M., Yppärilä-Wolters, H., Takala, P., Huiku, M., ... Korhonen, I. (2006). Novel multiparameter approach for measurement of nociception at skin incision during general anaesthesia. British Journal of Anaesthesia, 96(3), 367-376. https://doi.org/10.1093/bja/ael005
Rantanen, M. ; Yli-Hankala, A. ; van Gils, Mark ; Yppärilä-Wolters, Heidi ; Takala, P. ; Huiku, M. ; Kymäläinen, M. ; Seitsonen, E. ; Korhonen, Ilkka. / Novel multiparameter approach for measurement of nociception at skin incision during general anaesthesia. In: British Journal of Anaesthesia. 2006 ; Vol. 96, No. 3. pp. 367-376.
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abstract = "Background: Direct indicators for the evaluation of the nociceptive–anti-nociceptive balance during general anaesthesia do not exist. The aim of this study was to combine physiological parameters to obtain such an indicator.Methods: Fifty-five females scheduled for surgery under general anaesthesia combining target-controlled infusions of propofol and remifentanil were studied. Propofol was given to maintain state entropy (SE) at 50 and remifentanil was targeted at 1, 3 or 5 ng ml−1. The patients’ reactions and clinical signs of nociception, remifentanil levels and estimation of noxious intensity of incision were combined into a clinical score [Clinical Signs–Stimulus–Antinociception (CSSA)] to evaluate the nociceptive–anti-nociceptive balance. ECG, photoplethysmography (PPG), response entropy (RE) and SE were recorded from 60 s before to 120 s after skin incision. Differences between post- and pre-incision values of heart rate variability (HRV), PPG and pulse transition time related parameters were analysed off-line to evidence the best predictors of CSSA. Those best predictors of CSSA served to develop a response index of nociception (RN), scaled from 0 to 100. This index was further tested in 10 additional patients.Results: HRV, RE, RE–SE and PPG variability were the best predictors of CSSA. The prediction probability of RN at predicting CSSA was 0.78. RN response was higher after larger incision, in movers and with lower remifentanil concentrations.Conclusions: The empirically developed algorithm of RN leads to an index that seems to adequately estimate the nociceptive–anti-nociceptive balance at skin incision during general anaesthesia. In the future, CSSA may serve as a reference for studies investigating methods aimed at evaluating this pharmacodynamic component of anaesthesia.",
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Rantanen, M, Yli-Hankala, A, van Gils, M, Yppärilä-Wolters, H, Takala, P, Huiku, M, Kymäläinen, M, Seitsonen, E & Korhonen, I 2006, 'Novel multiparameter approach for measurement of nociception at skin incision during general anaesthesia', British Journal of Anaesthesia, vol. 96, no. 3, pp. 367-376. https://doi.org/10.1093/bja/ael005

Novel multiparameter approach for measurement of nociception at skin incision during general anaesthesia. / Rantanen, M.; Yli-Hankala, A. (Corresponding Author); van Gils, Mark; Yppärilä-Wolters, Heidi; Takala, P.; Huiku, M.; Kymäläinen, M.; Seitsonen, E.; Korhonen, Ilkka.

In: British Journal of Anaesthesia, Vol. 96, No. 3, 2006, p. 367-376.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Novel multiparameter approach for measurement of nociception at skin incision during general anaesthesia

AU - Rantanen, M.

AU - Yli-Hankala, A.

AU - van Gils, Mark

AU - Yppärilä-Wolters, Heidi

AU - Takala, P.

AU - Huiku, M.

AU - Kymäläinen, M.

AU - Seitsonen, E.

AU - Korhonen, Ilkka

N1 - Project code: T3SU00087

PY - 2006

Y1 - 2006

N2 - Background: Direct indicators for the evaluation of the nociceptive–anti-nociceptive balance during general anaesthesia do not exist. The aim of this study was to combine physiological parameters to obtain such an indicator.Methods: Fifty-five females scheduled for surgery under general anaesthesia combining target-controlled infusions of propofol and remifentanil were studied. Propofol was given to maintain state entropy (SE) at 50 and remifentanil was targeted at 1, 3 or 5 ng ml−1. The patients’ reactions and clinical signs of nociception, remifentanil levels and estimation of noxious intensity of incision were combined into a clinical score [Clinical Signs–Stimulus–Antinociception (CSSA)] to evaluate the nociceptive–anti-nociceptive balance. ECG, photoplethysmography (PPG), response entropy (RE) and SE were recorded from 60 s before to 120 s after skin incision. Differences between post- and pre-incision values of heart rate variability (HRV), PPG and pulse transition time related parameters were analysed off-line to evidence the best predictors of CSSA. Those best predictors of CSSA served to develop a response index of nociception (RN), scaled from 0 to 100. This index was further tested in 10 additional patients.Results: HRV, RE, RE–SE and PPG variability were the best predictors of CSSA. The prediction probability of RN at predicting CSSA was 0.78. RN response was higher after larger incision, in movers and with lower remifentanil concentrations.Conclusions: The empirically developed algorithm of RN leads to an index that seems to adequately estimate the nociceptive–anti-nociceptive balance at skin incision during general anaesthesia. In the future, CSSA may serve as a reference for studies investigating methods aimed at evaluating this pharmacodynamic component of anaesthesia.

AB - Background: Direct indicators for the evaluation of the nociceptive–anti-nociceptive balance during general anaesthesia do not exist. The aim of this study was to combine physiological parameters to obtain such an indicator.Methods: Fifty-five females scheduled for surgery under general anaesthesia combining target-controlled infusions of propofol and remifentanil were studied. Propofol was given to maintain state entropy (SE) at 50 and remifentanil was targeted at 1, 3 or 5 ng ml−1. The patients’ reactions and clinical signs of nociception, remifentanil levels and estimation of noxious intensity of incision were combined into a clinical score [Clinical Signs–Stimulus–Antinociception (CSSA)] to evaluate the nociceptive–anti-nociceptive balance. ECG, photoplethysmography (PPG), response entropy (RE) and SE were recorded from 60 s before to 120 s after skin incision. Differences between post- and pre-incision values of heart rate variability (HRV), PPG and pulse transition time related parameters were analysed off-line to evidence the best predictors of CSSA. Those best predictors of CSSA served to develop a response index of nociception (RN), scaled from 0 to 100. This index was further tested in 10 additional patients.Results: HRV, RE, RE–SE and PPG variability were the best predictors of CSSA. The prediction probability of RN at predicting CSSA was 0.78. RN response was higher after larger incision, in movers and with lower remifentanil concentrations.Conclusions: The empirically developed algorithm of RN leads to an index that seems to adequately estimate the nociceptive–anti-nociceptive balance at skin incision during general anaesthesia. In the future, CSSA may serve as a reference for studies investigating methods aimed at evaluating this pharmacodynamic component of anaesthesia.

KW - anaesthesia

KW - depth of anaesthesia

U2 - 10.1093/bja/ael005

DO - 10.1093/bja/ael005

M3 - Article

VL - 96

SP - 367

EP - 376

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

SN - 0007-0912

IS - 3

ER -