Meijer Fleur S, Niesters Marieke, van Velzen Monique, Martini Chris H, Olofsen Erik, Edry Ruth, Sessler Daniel I, van Dorp Eveline L A, Dahan Albert, Boon Martijn
Department of Anesthesiology, Leiden University Medical Center, Albinusdreef 2 (Postal Zone H5-Q), 2333 ZA, Leiden, The Netherlands.
Department of Anesthesiology, Rambam Medical Centre, The Ruth and Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel.
J Clin Monit Comput. 2020 Aug;34(4):629-641. doi: 10.1007/s10877-019-00362-4. Epub 2019 Jul 20.
Monitors that estimate nociception during anesthesia may be used to guide opioid and other analgesics administration to optimize anesthesia care and possibly outcome. We reviewed the literature to evaluate current evidence of the effect of nociception-guided management over standard anesthesia practice during surgery. A systematic review of the literature on the effect of nociception monitoring on anesthesia practice was conducted. Reports were eligible if they compared nociception-guided anesthesia to standard practice during surgery. Primary endpoint of this review is intraoperative opioid consumption. Secondary endpoints included hemodynamic control, postoperative pain and pain treatment. We identified 12 randomized controlled trials that compared one of five different nociception monitoring techniques to standard anesthesia care. Most studies were single center studies of small sample size. Six studies reported intraoperative opioid consumption as primary outcome. There was considerable variability with respect to surgical procedure and anesthesia technique. For nociception monitors that were investigated by more than one study, analysis of the pooled data was performed. The surgical plethysmographic index was the only monitor for which an intra operative opioid sparing effect was found. For the other monitors, either no effect was detected, or pooled analysis could not be performed due to paucity of study data. On secondary outcomes, no consistent effect of nociception-guided anesthesia could be established. Although some nociception monitors show promising results, no definitive conclusions regarding the effect of nociception monitoring on intraoperative opioid consumption or other anesthesia related outcome can be drawn.Clinical trial number PROSPERO ID 102913.
在麻醉期间估计伤害感受的监测仪可用于指导阿片类药物及其他镇痛药的给药，以优化麻醉护理并可能改善预后。我们回顾了文献，以评估手术期间伤害感受引导管理相对于标准麻醉实践效果的现有证据。对有关伤害感受监测对麻醉实践影响的文献进行了系统回顾。如果报告将手术期间伤害感受引导的麻醉与标准实践进行比较，则符合纳入标准。本综述的主要终点是术中阿片类药物的消耗量。次要终点包括血流动力学控制、术后疼痛及疼痛治疗。我们确定了12项随机对照试验，这些试验将五种不同的伤害感受监测技术之一与标准麻醉护理进行了比较。大多数研究是小样本量的单中心研究。六项研究将术中阿片类药物消耗量作为主要结局进行了报告。在手术程序和麻醉技术方面存在相当大的差异。对于有多项研究调查的伤害感受监测仪，对汇总数据进行了分析。外科体积描记指数是唯一被发现具有术中阿片类药物节省效应的监测仪。对于其他监测仪，要么未检测到效果，要么由于研究数据不足而无法进行汇总分析。在次要结局方面，无法确定伤害感受引导麻醉的一致效果。尽管一些伤害感受监测仪显示出有前景的结果，但关于伤害感受监测对术中阿片类药物消耗量或其他与麻醉相关结局的影响仍无法得出明确结论。临床试验编号：PROSPERO ID 102913。
