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October 26, 2015
3:15:00 PM - 5:15:00 PM
Room Hall B2-Area B
Ability of the Nociception Level to Detect Noxious Stimuli During Propofol-Remifentanil Anesthesia
Albert Dahan, M.D.,Ph.D., Christian H. Martini, M.D., Martijn Boon, M.D.
Leiden University Medical Center, Leiden, Netherlands
Disclosures: A. Dahan: H. Honoraria; Self; I received a honorarium to attend scientific advisory board meetings. C.H. Martini: None. M. Boon: None.
Introduction: A novel multidimensional index of nociception, the nociceptive level (NoL, Medasense Biometrics Ltd., Ramat Yishai, Israel) index, derived from the nonlinear composite of heart rate, heart rate variability, amplitude of the photo-plethysmogram, skin conductance, fluctuations in skin conductance and their time derivatives, was used to assess nociception during anesthesia.

Methods: Seventy-two ASA I-III patients received propofol (target bispectral index 45) and one of six remifentanil target concentrations in the range of 0 to 5 ng/mL. The NoL, mean arterial pressure (MAP, derived from a beat-to-beat finger cuff measurement) and heart rate (HR) were measured during non-noxious, moderate (skin incision) and intense noxious (intubation) stimulation. Values are average (95% confidence interval).

Results: NoL, HR and MAP did not change during non-noxious events. Incision increased HR by 1.3 (-0.46 to 3.1) min-1 (NS), MAP by 7.9 (-1.9 to 13.0 mmHg) mmHg (NS) and NoL by 8.0 (0.4 to 16.0) (p < 0.001). Intubation increased HR by 7.0 (1.4 to 12.0) min-1 (p < 0.001), MAP by 13.0 (3.1 to 20) mmHg (p < 0.001) mmHg and NoL by 18.0 (7.8-29.0) (p < 0.001). The ΔNoL area-under-the-curve (0.95) of the receiver operating characteristic curve was greater compared to ΔHR (0.84, p < 0.001) and ΔMAP (0.78, p < 0.001). Under non-nociceptive conditions, remifentanil had no effect on NoL, in contrast to HR and MAP that showed a dose-dependent decrease.

Discussion: The NoL is a reliable measure of moderate and intense noxious stimulation and outperforms HR and MAP in differentiating noxious from non-noxious stimuli. In contrast to HR and MAP, the NoL was not affected by hemodynamic effects of remifentanil.

Copyright © 2015 American Society of Anesthesiologists