J Clin Monit Comput - Variations of the analgesia nociception index during general anaesthesia for laparoscopic abdominal surgery.


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The analgesia nociception index (ANI) is an online heart rate variability analysis proposed for assessment of the antinociception/nociception balance. In this observational study, we compared ANI with heart rate (HR) and systolic blood pressure (SBP) during various noxious stimuli in anaesthetized patients. 15 adult patients undergoing laparoscopic appendectomy or cholecystectomy were studied. Patients received target controlled infusions of propofol (adjusted to maintain the Bispectral index in the range [40-60]) and remifentanil (with target increase in case of haemodynamic reactivity [increase in HR and/or SBP >20% of baseline]), and cisatracurium. Medical staff was blind to the ANI monitor. ANI and haemodynamic data were recorded at predefined times before and during surgery, including tetanic stimulation of the ulnar nerve before start of surgery. Anaesthesia induction decreased HR and SBP, while high ANI values (88 [17]) were recorded, indicating parasympathetic predominance. In 10 out of 11 patients, tetanic stimulation led to a transient (<5 min) decrease in ANI to 48 (40) whereas HR and SBP did not change. After start of surgery, ANI decreased to 60 (39) and decreased further to 50 (15) after the pneumoperitoneum was inflated, while there was no significant change in HR or SBP. When haemodynamic reactivity occurred, ANI had further decreased to 40 (15). After completion of surgery, ANI returned to 90 (34). ANI seems more sensitive than HR and SBP to moderate nociceptive stimuli in propofol-anaesthetized patients. Whether ANI monitoring may allow preventing haemodynamic reactivity to noxious stimuli remains to be demonstrated.

Resumo Limpo

analgesia nocicept index ani onlin heart rate variabl analysi propos assess antinociceptionnocicept balanc observ studi compar ani heart rate hr systol blood pressur sbp various noxious stimuli anaesthet patient adult patient undergo laparoscop appendectomi cholecystectomi studi patient receiv target control infus propofol adjust maintain bispectr index rang remifentanil target increas case haemodynam reactiv increas hr andor sbp baselin cisatracurium medic staff blind ani monitor ani haemodynam data record predefin time surgeri includ tetan stimul ulnar nerv start surgeri anaesthesia induct decreas hr sbp high ani valu record indic parasympathet predomin patient tetan stimul led transient min decreas ani wherea hr sbp chang start surgeri ani decreas decreas pneumoperitoneum inflat signific chang hr sbp haemodynam reactiv occur ani decreas complet surgeri ani return ani seem sensit hr sbp moder nocicept stimuli propofolanaesthet patient whether ani monitor may allow prevent haemodynam reactiv noxious stimuli remain demonstr

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