Sriganesh Kamath, Theerth Kaushic A, Reddy Madhusudan, Chakrabarti Dhritiman, Rao Ganne Sesha Umamaheswara
Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
Department of Neuroanaesthesia and Neurocritical Care, Rajagiri Hospital, Ernakulam, Kerala, India.
Indian J Anaesth. 2019 Feb;63(2):100-105. doi: 10.4103/ija.IJA_656_18.
Direct laryngoscopy and tracheal intubation is a noxious stimulation that induces significant stress response. Currently, this nociceptive response is assessed mainly by haemodynamic changes. Recently, analgesia nociception index (ANI) is introduced into anaesthesia practice and provides objective information about parasympathetic (low nociceptive stress) and sympathetic (high nociceptive stress) balance, which reflects the degree of intraoperative nociception/analgesia. This study evaluated the changes in ANI and haemodynamics during anaesthetic induction and intubation, and their correlation during tracheal intubation.
Sixty adult patients scheduled for elective brain tumour surgery under general anaesthesia were studied for changes in ANI, heart rate (HR) and mean blood pressure (MBP) during anaesthetic induction and intubation. This was a secondary analysis of a previously published trial. Linear mixed effects model was used to evaluate changes in ANI, HR and MBP and to test correlation between ANI and haemodynamics.
Anaesthetic induction reduced ANI (but not below the critical threshold of nociception of 50) and MBP, and increased the HR ( < 0.001). Direct laryngoscopy and tracheal intubation resulted in increase in HR and MBP with decrease in ANI below the threshold of 50 ( < 0.001). A linear negative correlation was observed between ANI and HR; r = -0.405, < 0.001, and ANI and MBP; r = -0.415, = 0.001.
Significant changes are observed in ANI during anaesthetic induction and intubation. There is a negative linear correlation between ANI and systemic haemodynamics during intubation.
直接喉镜检查和气管插管是一种有害刺激，可引发显著的应激反应。目前，这种伤害性反应主要通过血流动力学变化来评估。最近，镇痛伤害感受指数（ANI）被引入麻醉实践中，它提供了有关副交感神经（低伤害性应激）和交感神经（高伤害性应激）平衡的客观信息，反映了术中伤害感受/镇痛的程度。本研究评估了麻醉诱导和插管期间ANI和血流动力学的变化，以及气管插管期间它们之间的相关性。
对60例计划在全身麻醉下进行择期脑肿瘤手术的成年患者，研究其在麻醉诱导和插管期间ANI、心率（HR）和平均血压（MBP）的变化。这是对先前发表试验的二次分析。采用线性混合效应模型评估ANI、HR和MBP的变化，并测试ANI与血流动力学之间的相关性。
麻醉诱导使ANI降低（但未低于伤害感受的临界阈值50）和MBP降低，并使HR升高（<0.001）。直接喉镜检查和气管插管导致HR和MBP升高，同时ANI降至50以下阈值（<0.001）。观察到ANI与HR之间呈线性负相关；r = -0.405，<0.001，以及ANI与MBP之间；r = -0.415，= 0.001。
在麻醉诱导和插管期间观察到ANI有显著变化。插管期间ANI与全身血流动力学之间存在负线性相关。
