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DOI: 10.15265/IY-2015-004
Physiological Signal Processing for Individualized Anti-nociception Management During General Anesthesia: a Review
Summary
Objective: The aim of this paper is to review existing technologies for the nociception / anti-nociception balance evaluation during surgery under general anesthesia.
Methods: General anesthesia combines the use of analgesic, hypnotic and muscle-relaxant drugs in order to obtain a correct level of patient non-responsiveness during surgery. During the last decade, great efforts have been deployed in order to find adequate ways to measure how anesthetic drugs affect a patient’s response to surgical nociception. Nowadays, though some monitoring devices allow obtaining information about hypnosis and muscle relaxation, no gold standard exists for the nociception / anti-nociception balance evaluation. Articles from the PubMed literature search engine were reviewed. As this paper focused on surgery under general anesthesia, articles about nociception monitoring on conscious patients, in post-anesthesia care unit or in intensive care unit were not considered.
Results: In this article, we present a review of existing technologies for the nociception / anti-nociception balance evaluation, which is based in all cases on the analysis of the autonomous nervous system activity. Presented systems, based on sensors and physiological signals processing algorithms, allow studying the patients’ reaction regarding anesthesia and surgery.
Conclusion: Some technological solutions for nociception / antinociception balance monitoring were described. Though presented devices could constitute efficient solutions for individualized anti-nociception management during general anesthesia, this review of current literature emphasizes the fact that the choice to use one or the other mainly relies on the clinical context and the general purpose of the monitoring.
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Keywords
Physiologic monitoring - general anesthesia - nociception - tranducers - digital signal processing
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Conflict of interest
De Jonckheere J, Jeanne M and Logier R are scientific advisers for MDoloris Medical Systems, and own shares of MDoloris Medical Systems.
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References
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- 2 Bein B. Entropy. Best practice & research clinical anesthesiology 2006; 20 (Suppl. 01) 101-109.
- 3 Joly V, Richebé P, Guignard B, Fletcher D, Maurette P, Sessler DI. et al. Remifentanil-induced postoperative hyperalgesia and its prevention with small-dose ketamine. Anesthesiology 2005; 103: 147-55.
- 4 Larson MD, Sessler DI, Washington DE, Merrifield BR, Hynson JA, McGuire J. Pupillary response to noxious stimulation during isoflurane and propofol anesthesia. Anesth Analg 1993; 76: 1072-8.
- 5 Constant I, Nghe MC, Boudet L, Berniere J, Schrayer S, Seeman R. et al. Reflex pupillary dilatation in response to skin incision and alfentanil in children anaesthetized with sevoflurane: a more sensitive measure of noxious stimulation than the commonly used variable. Br J Anaesth 2006; 96: 614-9.
- 6 Isnardon S, Vinclair M, Genty C, Hebrard A, Albaladejo P, Payen J. Pupillometry to detect pain response during general anaesthesia following unilateral popliteal nerve block: a prospective, observational study. Eur J Anaesth 2013; 30: 429-34.
- 7 Huiku M, Uutela K, van Gils M, Korhonen I, Kymäläinen M, Meriläinen P. et al. Assessment of surgical stress during general anaesthesia. Br J Anaesth 2007; 98: 447-55.
- 8 Struys MM, Vanpeteghem C, Huiku M, Uutela K, Blyaert NB, Mortier EP. Changes in a surgical stress index in response to standardized pain stimuli during propofol-remifentanil infusion. Br J Anaesth 2007; 99: 359-67.
- 9 Bonhomme V, Uutela K, Hans G, Maquoi I, Born JD, Brichant JF. et al. Comparison of the surgical Pleth Index™ with haemodynamic variables to assess nociception-anti-nociception balance during general anaesthesia. Br J Anaesth 2011; 106: 101-11.
- 10 Chen X, Thee C, Gruenewald M, Wnent J, Illies C, Hoecker J. et al. Comparison of surgical stress index-guided analgesia with standard clinical practice during routine general anesthesia: a pilot study. Anesthesiology 2010; 112: 1175-83.
- 11 Bergmann I, (1) Göhner A, Crozier TA, Hesjedal B, Wiese CH, Popov A. et al. Surgical pleth index-guided remifentanil administration reduces remifentanil and propofol consumption and shortens recovery times in outpatient anaesthesia. Br J Anaesth 2013; Apr 1 10 (Suppl. 04) 622-8.
- 12 Storm H, Myre K, Rostrup M, Stokland O, Lien D, Raeder JC. Skin conductance correlates with perioperative stress. Acta Anaesthesiol Scand 2002; 46: 887-95.
- 13 Gjerstad AC, Storm H, Hagen R, Huiki M, Qvigstad E, Raeder J. Comparison of skin conductance with entropy during intubation, tetanic stimulation and emergence from general anaesthesia. Acta Anaesthesiol Scand 2007; 51: 8-15.
- 14 Jeanne M, Clement C, De Jonckheere J, Logier R, Tavernier B. Variations of the analgesia nociception index during general anaesthesia for laparoscopic abdominal surgery. J Clin Monit Comput 2012; 26: 289-94.
- 15 Jeanne M, Delecroix M, De Jonckheere J, Keribedj A, Logier R, Tavernier B. Variations of the Analgesia Nociception Index during propofol anesthesia for total knee replacement. Clin J Pain 2014; Dec 30 (Suppl. 12) 1084-8.
- 16 Boselli E, Bouvet L, Begou G, Torkmani S, Allaouchiche B. Prediction of haemodynamic reactivity during total intravenous anaesthesia for suspension laryngoscopy using Analgesia/Nociception Index (ANI): a prospective observational study. Minerva Anestesiol 2015; Mar 81 (Suppl. 03) 288-97.
- 17 Boselli E, Bouvet L, Bégou G, Dabouz R, Davidson J, Deloste JY. et al. Prediction of immediate postoperative pain using the analgesia/nociception index: a prospective observational study. Br J Anaesth 2014; 112: 715-21.
- 18 Cividjian A, Martinez JY, Combourieu E, Precloux P, Beraud AM, Rochette Y. et al. Beat by beat cardiovascular index to predict unexpected intra-operative movement in anesthetized unparalyzed patients: a retrospective study. J Clin Monit Comput 2007; 21: 91-101.
- 19 Martinez JY, Wey PF, Lions C, Cividjian A, Rabilloud M, Bissery A. et al. A beat by beat cardiovascular index, CARDEAN: A prospective randomized assessment of its utility for the reduction of movement during colonoscopy. Anesthes Analg 2010; 110: 765-72.
- 20 Rossi M, Cividjian A, Fevre MC, Oddoux ME, Carcey J, Halle C. et al. A beat by beat, on-line, cardiovascular index, CARDEAN, to assess circulatory response to surgery: a randomized clinical trial during spine surgery. J Clin Monit Comput 2012; 26: 441-9.
- 21 Brouse CJ, Karlen W, Myers D, Cooke E, Stinson J, Lim J. et al. Wavelet transform cardiorespiratory coherence detects patient movement during general anesthesia. Conf Proc IEEE Eng Med Biol Soc 2011; 2011: 6114-7.
- 22 Brouse CJ, Karlen W, Dumont GA, Myers D, Cooke E, Stinson J. et al. Monitoring nociception during generale anesthesia with cardiorespiratory coherence. J Clin Monit Comput 2013; 27: 551-60.
- 23 Ben-Israel N, Kliger M, Zuckerman G, Katz Y, Edry R. Monitoring the nociception level: a multi-parameter approach. J Clin Monit Comput 2013; 27: 659-68.
- 24 Sabourdin N, Arnaout M, Louvet N, Guye ML, Piana F, Constant I. Pain monitoring in anesthetized children: first assessment of skin conductance and analgesia nociception index at different infusion rates of remifentanil. PaediatrAnaesth 2013; 23: 149-55.
- 25 Ledowski T, Pascoe E, Ang B, Schmarbeck T, Clarke MW, Fuller C. et al. Monitoring of intra-operative nociception: skin conductance and surgical stress index versus stress hormone plasma level. Anaesthesia 2010; 65: 1001-6.
- 26 Migeon A, Desgranges FP, Chassard D, Blaise BJ, De Queiroz M, Stewart A. et al. Pupillary reflex dilatation and analgesia nociception index monitoring to assess the effectiveness of regional anesthesia in children anesthetised with sevoflurane. Paediatr Anaesth 2013; 23: 1160-5.
- 27 Gruenewald M, Ilies C, Herz J, Schoenherr T, Fudickar A, Hocker J. et al. Influence of nociceptive stimulation on analgesia nociception index (ANI) during propofol remifentanil anaesthesia. Br J Anaesth 2013; 110: 1024-30.
Correspondence to:
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References
- 1 Myles PS, Leslie K, McNeil J, Forbes A, Chan MT. Bispectral index monitoring to prevent awarness during anaesthesia : the B-Aware randomised controlled trial. Lancet 2004 May 29 363 9423 1757-63.
- 2 Bein B. Entropy. Best practice & research clinical anesthesiology 2006; 20 (Suppl. 01) 101-109.
- 3 Joly V, Richebé P, Guignard B, Fletcher D, Maurette P, Sessler DI. et al. Remifentanil-induced postoperative hyperalgesia and its prevention with small-dose ketamine. Anesthesiology 2005; 103: 147-55.
- 4 Larson MD, Sessler DI, Washington DE, Merrifield BR, Hynson JA, McGuire J. Pupillary response to noxious stimulation during isoflurane and propofol anesthesia. Anesth Analg 1993; 76: 1072-8.
- 5 Constant I, Nghe MC, Boudet L, Berniere J, Schrayer S, Seeman R. et al. Reflex pupillary dilatation in response to skin incision and alfentanil in children anaesthetized with sevoflurane: a more sensitive measure of noxious stimulation than the commonly used variable. Br J Anaesth 2006; 96: 614-9.
- 6 Isnardon S, Vinclair M, Genty C, Hebrard A, Albaladejo P, Payen J. Pupillometry to detect pain response during general anaesthesia following unilateral popliteal nerve block: a prospective, observational study. Eur J Anaesth 2013; 30: 429-34.
- 7 Huiku M, Uutela K, van Gils M, Korhonen I, Kymäläinen M, Meriläinen P. et al. Assessment of surgical stress during general anaesthesia. Br J Anaesth 2007; 98: 447-55.
- 8 Struys MM, Vanpeteghem C, Huiku M, Uutela K, Blyaert NB, Mortier EP. Changes in a surgical stress index in response to standardized pain stimuli during propofol-remifentanil infusion. Br J Anaesth 2007; 99: 359-67.
- 9 Bonhomme V, Uutela K, Hans G, Maquoi I, Born JD, Brichant JF. et al. Comparison of the surgical Pleth Index™ with haemodynamic variables to assess nociception-anti-nociception balance during general anaesthesia. Br J Anaesth 2011; 106: 101-11.
- 10 Chen X, Thee C, Gruenewald M, Wnent J, Illies C, Hoecker J. et al. Comparison of surgical stress index-guided analgesia with standard clinical practice during routine general anesthesia: a pilot study. Anesthesiology 2010; 112: 1175-83.
- 11 Bergmann I, (1) Göhner A, Crozier TA, Hesjedal B, Wiese CH, Popov A. et al. Surgical pleth index-guided remifentanil administration reduces remifentanil and propofol consumption and shortens recovery times in outpatient anaesthesia. Br J Anaesth 2013; Apr 1 10 (Suppl. 04) 622-8.
- 12 Storm H, Myre K, Rostrup M, Stokland O, Lien D, Raeder JC. Skin conductance correlates with perioperative stress. Acta Anaesthesiol Scand 2002; 46: 887-95.
- 13 Gjerstad AC, Storm H, Hagen R, Huiki M, Qvigstad E, Raeder J. Comparison of skin conductance with entropy during intubation, tetanic stimulation and emergence from general anaesthesia. Acta Anaesthesiol Scand 2007; 51: 8-15.
- 14 Jeanne M, Clement C, De Jonckheere J, Logier R, Tavernier B. Variations of the analgesia nociception index during general anaesthesia for laparoscopic abdominal surgery. J Clin Monit Comput 2012; 26: 289-94.
- 15 Jeanne M, Delecroix M, De Jonckheere J, Keribedj A, Logier R, Tavernier B. Variations of the Analgesia Nociception Index during propofol anesthesia for total knee replacement. Clin J Pain 2014; Dec 30 (Suppl. 12) 1084-8.
- 16 Boselli E, Bouvet L, Begou G, Torkmani S, Allaouchiche B. Prediction of haemodynamic reactivity during total intravenous anaesthesia for suspension laryngoscopy using Analgesia/Nociception Index (ANI): a prospective observational study. Minerva Anestesiol 2015; Mar 81 (Suppl. 03) 288-97.
- 17 Boselli E, Bouvet L, Bégou G, Dabouz R, Davidson J, Deloste JY. et al. Prediction of immediate postoperative pain using the analgesia/nociception index: a prospective observational study. Br J Anaesth 2014; 112: 715-21.
- 18 Cividjian A, Martinez JY, Combourieu E, Precloux P, Beraud AM, Rochette Y. et al. Beat by beat cardiovascular index to predict unexpected intra-operative movement in anesthetized unparalyzed patients: a retrospective study. J Clin Monit Comput 2007; 21: 91-101.
- 19 Martinez JY, Wey PF, Lions C, Cividjian A, Rabilloud M, Bissery A. et al. A beat by beat cardiovascular index, CARDEAN: A prospective randomized assessment of its utility for the reduction of movement during colonoscopy. Anesthes Analg 2010; 110: 765-72.
- 20 Rossi M, Cividjian A, Fevre MC, Oddoux ME, Carcey J, Halle C. et al. A beat by beat, on-line, cardiovascular index, CARDEAN, to assess circulatory response to surgery: a randomized clinical trial during spine surgery. J Clin Monit Comput 2012; 26: 441-9.
- 21 Brouse CJ, Karlen W, Myers D, Cooke E, Stinson J, Lim J. et al. Wavelet transform cardiorespiratory coherence detects patient movement during general anesthesia. Conf Proc IEEE Eng Med Biol Soc 2011; 2011: 6114-7.
- 22 Brouse CJ, Karlen W, Dumont GA, Myers D, Cooke E, Stinson J. et al. Monitoring nociception during generale anesthesia with cardiorespiratory coherence. J Clin Monit Comput 2013; 27: 551-60.
- 23 Ben-Israel N, Kliger M, Zuckerman G, Katz Y, Edry R. Monitoring the nociception level: a multi-parameter approach. J Clin Monit Comput 2013; 27: 659-68.
- 24 Sabourdin N, Arnaout M, Louvet N, Guye ML, Piana F, Constant I. Pain monitoring in anesthetized children: first assessment of skin conductance and analgesia nociception index at different infusion rates of remifentanil. PaediatrAnaesth 2013; 23: 149-55.
- 25 Ledowski T, Pascoe E, Ang B, Schmarbeck T, Clarke MW, Fuller C. et al. Monitoring of intra-operative nociception: skin conductance and surgical stress index versus stress hormone plasma level. Anaesthesia 2010; 65: 1001-6.
- 26 Migeon A, Desgranges FP, Chassard D, Blaise BJ, De Queiroz M, Stewart A. et al. Pupillary reflex dilatation and analgesia nociception index monitoring to assess the effectiveness of regional anesthesia in children anesthetised with sevoflurane. Paediatr Anaesth 2013; 23: 1160-5.
- 27 Gruenewald M, Ilies C, Herz J, Schoenherr T, Fudickar A, Hocker J. et al. Influence of nociceptive stimulation on analgesia nociception index (ANI) during propofol remifentanil anaesthesia. Br J Anaesth 2013; 110: 1024-30.