Sabourdin Nada, Arnaout Michel, Louvet Nicolas, Guye Marie-Laurence, Piana Federica, Constant Isabelle
Department of Anesthesiology, Armand Trousseau Hospital, AP-HP, UPMC, Paris, France.
Paediatr Anaesth. 2013 Feb;23(2):149-55. doi: 10.1111/pan.12071. Epub 2012 Nov 21.
Analgesia and nociception can not be specifically monitored during general anesthesia. Movement of the patient or hemodynamic variations are usually considered as symptoms of insufficient analgesia. The measure of skin conductance (SC) allows an assessment of peripheral sympathetic activity. The analgesia-nociception index (ANI) provides an evaluation of the parasympathetic activity based on heart rate variability. These two non-invasive monitors might allow a better assessment of perioperative nociception.
Describe the profiles of SC and ANI after a standardized nociceptive stimulation, in anesthetized children, at different infusion rates of remifentanil.
MATERIALS/METHODS: For this pilot study, 12 children (8.4 ± 5 years) scheduled for middle-ear surgery were anesthetized with desflurane to maintain a bispectral index at 50. Remifentanil was used for analgesia, at an initial infusion rate of 0.2 μg·kg(-1) ·min(-1) . Remifentanil infusion rate was then decreased: Five steady-state periods of 10 min were obtained at 0.2, 0.16, 0.12, 0.08, and 0.04 μg·kg(-1) ·min(-1) . At the end of each period, a standardized tetanic stimulation was applied to the patient. Variations in heart rate, blood pressure, SC, and ANI were recorded before and after each stimulation.
After the stimulation, ANI was significantly decreased compared with prestimulation values for all remifentanil infusion rates. This decrease was greater at 0.04 μg·kg(-1) ·min(-1) than at the other infusion rates. SC, heart rate, and blood pressure were not modified by the stimulations, whatever the dose of remifentanil.
ANI might provide a more sensitive assessment of nociception in anesthetized children than hemodynamic parameters or skin conductance.
在全身麻醉期间无法特异性监测镇痛和伤害感受。患者的运动或血流动力学变化通常被视为镇痛不足的症状。皮肤电导（SC）的测量可用于评估外周交感神经活动。镇痛-伤害感受指数（ANI）基于心率变异性对副交感神经活动进行评估。这两种非侵入性监测方法可能有助于更好地评估围手术期的伤害感受。
描述在不同瑞芬太尼输注速率下，麻醉儿童在接受标准化伤害性刺激后SC和ANI的变化情况。
材料/方法：在这项初步研究中，12名计划接受中耳手术的儿童（8.4±5岁）接受地氟烷麻醉，维持脑电双频指数在50。使用瑞芬太尼进行镇痛，初始输注速率为0.2μg·kg⁻¹·min⁻¹。随后降低瑞芬太尼输注速率：在0.2、0.16、0.12、0.08和0.04μg·kg⁻¹·min⁻¹时分别获得五个10分钟的稳态期。在每个时间段结束时，对患者施加标准化的强直刺激。记录每次刺激前后心率、血压以及SC和ANI的变化。
刺激后，所有瑞芬太尼输注速率下的ANI均较刺激前显著降低。在0.04μg·kg⁻¹·min⁻¹时的降低幅度大于其他输注速率。无论瑞芬太尼剂量如何，刺激均未改变SC、心率和血压。
对于麻醉儿童，ANI可能比血流动力学参数或皮肤电导更能敏感地评估伤害感受。
