Jeanne Mathieu, Delecroix Michel, De Jonckheere Julien, Keribedj Abdel, Logier Régis, Tavernier Benoît
*Pôle d'Anesthésie Réanimation, Centre Hospitalier Universitaire †Cic-It 807 Inserm, Centre Hospitalier Universitaire, Lille, France.
Clin J Pain. 2014 Dec;30(12):1084-8. doi: 10.1097/AJP.0000000000000083.
The Analgesia Nociception Index (ANI) monitor measures the relative parasympathetic tone as a surrogate for the antinociception/nociception balance during general anesthesia. The aims of this observational study were to test whether ANI could early detect hemodynamic reactivity (HemodR) during propofol anesthesia, measure pain in conscious patients after surgery, and determine ANI predictive thresholds.
After institutional approval and informed consent, adult patients scheduled for total knee replacement were included. Propofol was administered using a target-controlled infusion device, and sufentanil was administered at induction and in case of "HemodR," defined as a 20% increase in heart rate or systolic blood pressure. Data were collected before the start of surgery (NoStim), in case of "HemodR," and after awakening before and after the pain had been treated by truncular analgesia. Nonparametric tests were conducted. Thresholds were determined using an receiver operating characteristic analysis. Results are presented as median (interquartile range).
A total of 27 patients have been analysed. ANI decreased from 82 (30) at "NoStim" to 47 (22) at "HemodR," whereas heart rate increased moderately from 61 (14) to 65 (18) and systolic blood pressure increased significantly from 91 mm Hg (16 mm Hg) to 151 mm Hg (25 mm Hg). Receiver operating characteristic analysis led to a threshold of 63 for "HemodR" detection (sensitivity=80%, specificity=88%, area under the curve=0.92), whereas ANI performance in awake patients was lower.
ANI measures during propofol anesthesia are coherent with the evolution of the analgesia/nociception balance, although its performance decreases in awake patients. Further clinical validation should focus on demonstrating the benefit of maintaining ANI over 63 during surgery.
镇痛伤害感受指数（ANI）监测仪可测量相对副交感神经张力，作为全身麻醉期间抗伤害感受/伤害感受平衡的替代指标。本观察性研究的目的是测试ANI是否能在丙泊酚麻醉期间早期检测血流动力学反应性（HemodR），测量术后清醒患者的疼痛程度，并确定ANI预测阈值。
经机构批准并获得知情同意后，纳入计划进行全膝关节置换术的成年患者。使用靶控输注装置给予丙泊酚，并在诱导时以及出现定义为心率或收缩压升高20%的“HemodR”时给予舒芬太尼。在手术开始前（无刺激）、出现“HemodR”时以及在经躯干镇痛治疗疼痛前后的清醒状态下收集数据。进行非参数检验。使用受试者工作特征分析确定阈值。结果以中位数（四分位间距）表示。
共分析了27例患者。ANI从“无刺激”时的82（30）降至“HemodR”时的47（22），而心率从61（14）适度增加至65（18），收缩压从91 mmHg（16 mmHg）显著增加至151 mmHg（25 mmHg）。受试者工作特征分析得出“HemodR”检测的阈值为63（敏感性=80%，特异性=88%，曲线下面积=0.92），而ANI在清醒患者中的表现较低。
丙泊酚麻醉期间的ANI测量结果与镇痛/伤害感受平衡的变化一致，尽管其在清醒患者中的表现有所下降。进一步的临床验证应侧重于证明在手术期间将ANI维持在63以上的益处。
