J Clin Monit Comput - Monitoring the nociception level: a multi-parameter approach.

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Resumo

The aim of the present study was to develop and validate an objective index for nociception level (NoL) of patients under general anesthesia, based on a combination of multiple physiological parameters. Twenty-five patients scheduled for elective surgery were enrolled. For clinical reference of NoL, the combined index of stimulus and analgesia was defined as a composite of the surgical stimulus level and a scaled effect-site concentration of opioid. The physiological parameters heart rate, heart rate variability (0.15-0.4?Hz band power), plethysmograph wave amplitude, skin conductance level, number of skin conductance fluctuations, and their time derivatives, were extracted. Two techniques to incorporate these parameters into a single index representing the NoL have been proposed: NoLlinear, based on an ordinary linear regression, and NoLnon-linear, based on a non-linear Random Forest regression. NoLlinear and NoLnon-linear significantly increased after moderate to severe noxious stimuli (Wilcoxon rank test, p?<?0.01), while the individual parameters only partially responded. Receiver operating curve analysis showed that NoL index based on both techniques better discriminated noxious and non-noxious surgical events [area under curve (AUC)?=?0.97] compared with individual parameters (AUC?=?0.56-0.74). NoLnon-linear better ranked the level of nociception compared with NoLlinear (R?=?0.88 vs. 0.77, p?<?0.01). These results demonstrate the superiority of multi-parametric approach over any individual parameter in the evaluation of nociceptive response. In addition, advanced non-linear technique may have an advantage over ordinary linear regression for computing NoL index. Further research will define the usability of the NoL index as a clinical tool to assess the level of nociception during general anesthesia.

Resumo Limpo

aim present studi develop valid object index nocicept level nol patient general anesthesia base combin multipl physiolog paramet twentyf patient schedul elect surgeri enrol clinic refer nol combin index stimulus analgesia defin composit surgic stimulus level scale effectsit concentr opioid physiolog paramet heart rate heart rate variabl hz band power plethysmograph wave amplitud skin conduct level number skin conduct fluctuat time deriv extract two techniqu incorpor paramet singl index repres nol propos nollinear base ordinari linear regress nolnonlinear base nonlinear random forest regress nollinear nolnonlinear signific increas moder sever noxious stimuli wilcoxon rank test p individu paramet partial respond receiv oper curv analysi show nol index base techniqu better discrimin noxious nonnoxi surgic event area curv auc compar individu paramet auc nolnonlinear better rank level nocicept compar nollinear r vs p result demonstr superior multiparametr approach individu paramet evalu nocicept respons addit advanc nonlinear techniqu may advantag ordinari linear regress comput nol index research will defin usabl nol index clinic tool assess level nocicept general anesthesia

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