Kim Seung Hyun, Chang Chul Ho, Lee Jeong-Rim, Seo Seok Kyo, Kwon Young In, Lee Jae Hoon
Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea.
Front Med (Lausanne). 2023 Aug 4;10:1196153. doi: 10.3389/fmed.2023.1196153. eCollection 2023.
The analgesia nociception index (ANI) monitor is a nociception monitoring device based on heart rate variability. We aimed to determine the effect of ANI monitor-based intraoperative nociception control on the perioperative stress response during laparoscopic surgery in the Trendelenburg position.
Altogether, 72 female patients who underwent total laparoscopic hysterectomy were randomized to either the control or ANI group. Intraoperative nociception was controlled by remifentanil administration in a conventional manner (based on blood pressure and heart rate) in the control group and by ANI monitoring in the ANI group. Perioperative stress responses were estimated by measuring the levels of serum catecholamines and catabolic stress hormones at three timepoints: after loss of consciousness, at the end of surgery, and 1 h after the end of surgery.
The serum cortisol level at the end of surgery was significantly higher in the ANI group than in the control group ( < 0.001), although more remifentanil was administered in the ANI group than in the control group ( < 0.001). Changes in the other estimators' levels were comparable between groups during the perioperative period. The hemodynamic profiles during surgery were also significantly different between the two groups. Phenylephrine use to treat hypotension was more common in the ANI group than in the control group ( = 0.005). However, postoperative clinical outcomes such as pain and nausea/vomiting did not differ between groups.
ANI monitor-based nociception control in laparoscopic surgery in the Trendelenburg position did not improve perioperative stress responses, intraoperative opioid consumption, or postoperative clinical outcomes. ClinicalTrials.gov (NCT04343638).
镇痛伤害感受指数（ANI）监测仪是一种基于心率变异性的伤害感受监测设备。我们旨在确定在头低脚高位腹腔镜手术中，基于ANI监测仪的术中伤害感受控制对围手术期应激反应的影响。
总共72例行全腹腔镜子宫切除术的女性患者被随机分为对照组或ANI组。对照组以传统方式（基于血压和心率）通过输注瑞芬太尼控制术中伤害感受，ANI组则通过ANI监测进行控制。在三个时间点测量血清儿茶酚胺和分解代谢应激激素水平，以评估围手术期应激反应：意识消失后、手术结束时和手术结束后1小时。
尽管ANI组输注的瑞芬太尼比对照组多（<0.001），但手术结束时ANI组的血清皮质醇水平显著高于对照组（<0.001）。围手术期两组间其他评估指标水平的变化相当。两组手术期间的血流动力学特征也有显著差异。ANI组使用去氧肾上腺素治疗低血压比对照组更常见（=0.005）。然而，两组间术后疼痛和恶心/呕吐等临床结局并无差异。
在头低脚高位腹腔镜手术中，基于ANI监测仪的伤害感受控制并未改善围手术期应激反应、术中阿片类药物消耗量或术后临床结局。ClinicalTrials.gov（NCT04343638）。
