University of Tampere, Medical School, Tampere, Finland.
Comput Methods Programs Biomed. 2011 Nov;104(2):154-60. doi: 10.1016/j.cmpb.2010.10.001. Epub 2010 Oct 30.
Analgesia is an important part of general anaesthesia, but no direct indicators of nociceptive-anti-nociceptive balance have been validated in detail. The Response Index of Nociception (RN) is a multiparameter approach which combines photoplethysmographic waveform (PPG), State Entropy (SE), Response Entropy (RE), and heart rate variability (HRV). We aimed at evaluating RN during general anaesthesia; especially we wanted to compare pre- and post-index values of certain noxious stimuli to the average index values. Our assumption was that RN could be a useful indicator of nociceptive-anti-nociceptive balance during the surgery.
Sixty women undergoing gynaecological or breast surgery participated in the study. All patients had elective surgery and anaesthesia was maintained with propofol-remifentanil target controlled infusion. Neuromuscular blocking agent rocuronium was used at the beginning of the surgery. Electrocardiography (ECG), photoplethysmography (PPG) and electroencelophalography (EEG) were registered and extracted off-line. An index, reflecting amplitude and frequency of occurrence of abrupt increases ("peaks") in the RN was evaluated during surgery in general and around occurrences of predefined noxious stimuli in particular.
Fifty-four patients were eligible for analysis. Patient movement was associated with increased index values, both before and after the event. Post-event values of the index for intubation and skin incision were higher than its intra-surgery baseline, while pre-event values remained unchanged.
Changes in RN can be used to detect noxious stimuli during surgery. RN also predicted movement in our patients under propofol-remifentanil anaesthesia.
镇痛是全身麻醉的重要组成部分，但尚未详细验证痛觉-抗痛觉平衡的直接指标。伤害感受反应指数（RN）是一种多参数方法，它结合了光容积脉搏波图（PPG）、状态熵（SE）、反应熵（RE）和心率变异性（HRV）。我们旨在评估全身麻醉期间的 RN；特别是我们希望比较某些伤害性刺激前后指数值与平均指数值。我们的假设是，RN 可以成为手术期间痛觉-抗痛觉平衡的有用指标。
60 名接受妇科或乳房手术的女性参与了这项研究。所有患者均接受择期手术，采用丙泊酚-瑞芬太尼靶控输注维持麻醉。在手术开始时使用神经肌肉阻滞剂罗库溴铵。记录心电图（ECG）、光容积脉搏波图（PPG）和脑电图（EEG），并离线提取。在手术期间评估反映 RN 中幅度和出现频率的突然增加（“峰值”）的指数，特别是在发生预定义伤害性刺激时。
54 名患者符合分析条件。患者运动与指数值增加有关，无论是在事件之前还是之后。与手术中的基线值相比，插管和皮肤切开时的指数后事件值较高，而前事件值保持不变。
RN 的变化可用于检测手术过程中的伤害性刺激。在我们接受丙泊酚-瑞芬太尼麻醉的患者中，RN 还可以预测运动。
