Jozefowicz Elsa, Sabourdin Nada, Fontaine Vincent, Lambelin Veronique, Lejeune Vincent, Menu Herve, Bourai Mohamed, Tavernier Benoit
CHU Lille, Pôle d'Anesthésie-Réanimation, 59000, Lille, France.
Department of Anesthesiology, Armand Trousseau University Hospital, DMU DREAM, APHP, GRC 29, Sorbonne Université, Paris, France.
J Clin Monit Comput. 2022 Feb;36(1):93-101. doi: 10.1007/s10877-020-00624-6. Epub 2021 Jan 2.
The ANI is a nociception monitor based on the high frequency parts of heart rate variability. Tracheal intubation may induce potentially deleterious hemodynamic disturbances or motor reactions if analgesia is inadequate. We investigated whether ANI modification generated by a standardized moderate short tetanic stimulation performed before laryngoscopy could predict hemodynamic or somatic reactions to subsequent intubation. We designed a prospective, interventional, monocentric, pilot study. Regional ethics board approved the study, written informed consent was obtained from each participant. Before laryngoscopy, under steady-state total intravenous anaesthesia with propofol and remifentanil, the ulnar nerve was stimulated with a 5 s tetanus (70 mA, 50 Hz). After another steady-state period, orotracheal intubation was performed. ANI variation, hemodynamic parameters and somatic reactions associated with tetanus and intubation were collected. To assess the predictability of hemodynamic or somatic reaction during laryngoscopy by tetanus-induced ANI variation, we calculated the area under the corresponding Receiver Operating Characteristic curve (AUCROC) and the 95% confidence intervals. Thirty-five patients were analyzed. ANI decreased by 21 ± 17 after tetanus. Regarding the ability of tetanus-induced ANI variation to predict hemodynamic or somatic reactions during subsequent intubation, the AUCROCs [95% CI] were 0.61 [0.41-0.81] and 0.52 [0.31-0.72] respectively. ANI varied after a short moderate tetanic stimulation performed before laryngoscopy but this variation was not predictive of a hemodynamic or somatic reaction during intubation.Trial registration NCT04354311, April 20th 2020, retrospectively registered.
ANI是一种基于心率变异性高频部分的伤害性监测仪。如果镇痛不充分，气管插管可能会引发潜在有害的血流动力学紊乱或运动反应。我们研究了在喉镜检查前进行标准化中度短强直刺激所产生的ANI变化是否能够预测随后插管时的血流动力学或躯体反应。我们设计了一项前瞻性、干预性、单中心的试点研究。地区伦理委员会批准了该研究，每位参与者均签署了书面知情同意书。在喉镜检查前，在丙泊酚和瑞芬太尼维持的稳态全静脉麻醉下，用5秒的强直刺激（70毫安，50赫兹）刺激尺神经。在另一个稳态期后，进行经口气管插管。收集与强直刺激和插管相关的ANI变化、血流动力学参数和躯体反应。为了评估强直刺激诱导的ANI变化对喉镜检查期间血流动力学或躯体反应的预测能力，我们计算了相应的受试者操作特征曲线下面积（AUCROC）和95%置信区间。对35例患者进行了分析。强直刺激后ANI下降了21±17。关于强直刺激诱导的ANI变化预测随后插管时血流动力学或躯体反应的能力，AUCROC[95%CI]分别为0.61[0.41 - 0.81]和0.52[0.31 - 0.72]。在喉镜检查前进行短时间中度强直刺激后ANI发生了变化，但这种变化并不能预测插管期间的血流动力学或躯体反应。试验注册号NCT04354311，2020年4月20日，回顾性注册。
