Response index of nociception correlates both with remifentanil concentration and level of painful stimulation during surgery

Markku Rantanen, Arvi Yli-Hankala, Ilkka Korhonen, Mark van Gils, Heidi Yppärilä-Wolters, Matti Huiku, Minna Kymäläinen, Pekka Meriläinen, Kimmo Uutela, Hanna Viertiö-Oja

Research output: Contribution to journalOther journal contributionScientificpeer-review

Abstract

Background and Goal of Study: No numeric measures of nociception during general anaesthesia exist. For monitoring of nociception a multi-parameter approach may be needed (1). We studied the relation between physiological responses and concentration of remifentanil (Rem) at nociceptive stimuli in anaesthetised and paralysed patients. Materials and Methods: 55 females were anaesthetised with propofol (Pr)-Rem target controlled infusions (TCI). Pr was given to maintain EEG State Entropy (SE) at 35-60. Rem TCI was randomised to 1, 3, or 5 ng/ml. Responses to tetanic stimulation of the ulnar nerve (30 s) were studied before surgery in a subgroup of 23 patients. Responses to skin incision were analysed in all patients. Comparison of responses in photoplethysmographic wave amplitude (PPGA), ECG beat-to-beat interval (RRI), and Response Entropy (RE) at different Rem levels was done using the Kruskal-Wallis H test. Results and Discussion: RRI (p=0.00001) and PPGA (p=0.009) responses to tetanic stimulus differed significantly between Rem levels, while for the incision RRI (p=0.019), RRI SD1 (p=0.019) and RE-SE (p=0.018) responses were different. A Response Index of Nociception (RN), developed by combining RE, RRI and PPGA variability, was significantly higher in the low doses of Rem as compared with the higher doses for both tetanic stimulus (p=0.00005) and skin incision (p=0.00003). Conclusions: In paralysed patients anaesthetised with propofol-remifentanil infusions: 1) Combination of information from RE, PPG, and RRI provides promising quantification of responses to abrupt noxious stimuli; 2) Long-lasting 30 sec tetanic stimulus induces qualitatively similar physiological responses as skin incision. Reference: 1) Seitsonen E. Anesthesiology 2002: 97: A-582 (abstract)
Original languageEnglish
Article numberA-114
Pages (from-to)31-32
JournalEuropean Journal of Anaesthesiology
Volume22
Publication statusPublished - 2005
MoE publication typeA1 Journal article-refereed
EventAnnual Meeting of the European Society of Anesthesiology, Euroanaesthesia 2005 - Vienna, Austria
Duration: 28 May 200531 May 2005

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Nociception
Entropy
Propofol
Skin
Ulnar Nerve
Anesthesiology
remifentanil
General Anesthesia
Electroencephalography
Electrocardiography

Cite this

Rantanen, M., Yli-Hankala, A., Korhonen, I., van Gils, M., Yppärilä-Wolters, H., Huiku, M., ... Viertiö-Oja, H. (2005). Response index of nociception correlates both with remifentanil concentration and level of painful stimulation during surgery. European Journal of Anaesthesiology, 22, 31-32. [A-114].
Rantanen, Markku ; Yli-Hankala, Arvi ; Korhonen, Ilkka ; van Gils, Mark ; Yppärilä-Wolters, Heidi ; Huiku, Matti ; Kymäläinen, Minna ; Meriläinen, Pekka ; Uutela, Kimmo ; Viertiö-Oja, Hanna. / Response index of nociception correlates both with remifentanil concentration and level of painful stimulation during surgery. In: European Journal of Anaesthesiology. 2005 ; Vol. 22. pp. 31-32.
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title = "Response index of nociception correlates both with remifentanil concentration and level of painful stimulation during surgery",
abstract = "Background and Goal of Study: No numeric measures of nociception during general anaesthesia exist. For monitoring of nociception a multi-parameter approach may be needed (1). We studied the relation between physiological responses and concentration of remifentanil (Rem) at nociceptive stimuli in anaesthetised and paralysed patients. Materials and Methods: 55 females were anaesthetised with propofol (Pr)-Rem target controlled infusions (TCI). Pr was given to maintain EEG State Entropy (SE) at 35-60. Rem TCI was randomised to 1, 3, or 5 ng/ml. Responses to tetanic stimulation of the ulnar nerve (30 s) were studied before surgery in a subgroup of 23 patients. Responses to skin incision were analysed in all patients. Comparison of responses in photoplethysmographic wave amplitude (PPGA), ECG beat-to-beat interval (RRI), and Response Entropy (RE) at different Rem levels was done using the Kruskal-Wallis H test. Results and Discussion: RRI (p=0.00001) and PPGA (p=0.009) responses to tetanic stimulus differed significantly between Rem levels, while for the incision RRI (p=0.019), RRI SD1 (p=0.019) and RE-SE (p=0.018) responses were different. A Response Index of Nociception (RN), developed by combining RE, RRI and PPGA variability, was significantly higher in the low doses of Rem as compared with the higher doses for both tetanic stimulus (p=0.00005) and skin incision (p=0.00003). Conclusions: In paralysed patients anaesthetised with propofol-remifentanil infusions: 1) Combination of information from RE, PPG, and RRI provides promising quantification of responses to abrupt noxious stimuli; 2) Long-lasting 30 sec tetanic stimulus induces qualitatively similar physiological responses as skin incision. Reference: 1) Seitsonen E. Anesthesiology 2002: 97: A-582 (abstract)",
author = "Markku Rantanen and Arvi Yli-Hankala and Ilkka Korhonen and {van Gils}, Mark and Heidi Ypp{\"a}ril{\"a}-Wolters and Matti Huiku and Minna Kym{\"a}l{\"a}inen and Pekka Meril{\"a}inen and Kimmo Uutela and Hanna Vierti{\"o}-Oja",
note = "abstract only",
year = "2005",
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pages = "31--32",
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Rantanen, M, Yli-Hankala, A, Korhonen, I, van Gils, M, Yppärilä-Wolters, H, Huiku, M, Kymäläinen, M, Meriläinen, P, Uutela, K & Viertiö-Oja, H 2005, 'Response index of nociception correlates both with remifentanil concentration and level of painful stimulation during surgery', European Journal of Anaesthesiology, vol. 22, A-114, pp. 31-32.

Response index of nociception correlates both with remifentanil concentration and level of painful stimulation during surgery. / Rantanen, Markku; Yli-Hankala, Arvi; Korhonen, Ilkka; van Gils, Mark; Yppärilä-Wolters, Heidi; Huiku, Matti; Kymäläinen, Minna; Meriläinen, Pekka; Uutela, Kimmo; Viertiö-Oja, Hanna.

In: European Journal of Anaesthesiology, Vol. 22, A-114, 2005, p. 31-32.

Research output: Contribution to journalOther journal contributionScientificpeer-review

TY - JOUR

T1 - Response index of nociception correlates both with remifentanil concentration and level of painful stimulation during surgery

AU - Rantanen, Markku

AU - Yli-Hankala, Arvi

AU - Korhonen, Ilkka

AU - van Gils, Mark

AU - Yppärilä-Wolters, Heidi

AU - Huiku, Matti

AU - Kymäläinen, Minna

AU - Meriläinen, Pekka

AU - Uutela, Kimmo

AU - Viertiö-Oja, Hanna

N1 - abstract only

PY - 2005

Y1 - 2005

N2 - Background and Goal of Study: No numeric measures of nociception during general anaesthesia exist. For monitoring of nociception a multi-parameter approach may be needed (1). We studied the relation between physiological responses and concentration of remifentanil (Rem) at nociceptive stimuli in anaesthetised and paralysed patients. Materials and Methods: 55 females were anaesthetised with propofol (Pr)-Rem target controlled infusions (TCI). Pr was given to maintain EEG State Entropy (SE) at 35-60. Rem TCI was randomised to 1, 3, or 5 ng/ml. Responses to tetanic stimulation of the ulnar nerve (30 s) were studied before surgery in a subgroup of 23 patients. Responses to skin incision were analysed in all patients. Comparison of responses in photoplethysmographic wave amplitude (PPGA), ECG beat-to-beat interval (RRI), and Response Entropy (RE) at different Rem levels was done using the Kruskal-Wallis H test. Results and Discussion: RRI (p=0.00001) and PPGA (p=0.009) responses to tetanic stimulus differed significantly between Rem levels, while for the incision RRI (p=0.019), RRI SD1 (p=0.019) and RE-SE (p=0.018) responses were different. A Response Index of Nociception (RN), developed by combining RE, RRI and PPGA variability, was significantly higher in the low doses of Rem as compared with the higher doses for both tetanic stimulus (p=0.00005) and skin incision (p=0.00003). Conclusions: In paralysed patients anaesthetised with propofol-remifentanil infusions: 1) Combination of information from RE, PPG, and RRI provides promising quantification of responses to abrupt noxious stimuli; 2) Long-lasting 30 sec tetanic stimulus induces qualitatively similar physiological responses as skin incision. Reference: 1) Seitsonen E. Anesthesiology 2002: 97: A-582 (abstract)

AB - Background and Goal of Study: No numeric measures of nociception during general anaesthesia exist. For monitoring of nociception a multi-parameter approach may be needed (1). We studied the relation between physiological responses and concentration of remifentanil (Rem) at nociceptive stimuli in anaesthetised and paralysed patients. Materials and Methods: 55 females were anaesthetised with propofol (Pr)-Rem target controlled infusions (TCI). Pr was given to maintain EEG State Entropy (SE) at 35-60. Rem TCI was randomised to 1, 3, or 5 ng/ml. Responses to tetanic stimulation of the ulnar nerve (30 s) were studied before surgery in a subgroup of 23 patients. Responses to skin incision were analysed in all patients. Comparison of responses in photoplethysmographic wave amplitude (PPGA), ECG beat-to-beat interval (RRI), and Response Entropy (RE) at different Rem levels was done using the Kruskal-Wallis H test. Results and Discussion: RRI (p=0.00001) and PPGA (p=0.009) responses to tetanic stimulus differed significantly between Rem levels, while for the incision RRI (p=0.019), RRI SD1 (p=0.019) and RE-SE (p=0.018) responses were different. A Response Index of Nociception (RN), developed by combining RE, RRI and PPGA variability, was significantly higher in the low doses of Rem as compared with the higher doses for both tetanic stimulus (p=0.00005) and skin incision (p=0.00003). Conclusions: In paralysed patients anaesthetised with propofol-remifentanil infusions: 1) Combination of information from RE, PPG, and RRI provides promising quantification of responses to abrupt noxious stimuli; 2) Long-lasting 30 sec tetanic stimulus induces qualitatively similar physiological responses as skin incision. Reference: 1) Seitsonen E. Anesthesiology 2002: 97: A-582 (abstract)

M3 - Other journal contribution

VL - 22

SP - 31

EP - 32

JO - European Journal of Anaesthesiology

JF - European Journal of Anaesthesiology

SN - 0265-0215

M1 - A-114

ER -