Norbeck Daniel Widarsson, Lindgren Sophie, Wolf Axel, Jildenstål Pether
Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Anaesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden.
BMC Anesthesiol. 2025 Jan 31;25(1):51. doi: 10.1186/s12871-025-02923-4.
Inadequate or excessive nociceptive control during general anesthesia can result in significant adverse outcomes. Using traditional clinical variables, such as heart rate, systolic blood pressure, and respiratory rate, to assess and manage nociceptive responses is often insufficient and could lead to overtreatment with both anesthetics and opioids. This study evaluated the feasibility and effectiveness of three nociception monitoring techniques Nociception Level Index (NOL), Skin Conductance Algesimeter (SCA) and heart rate monitoring in patients undergoing image-guided, minimally invasive abdominal interventions under general anesthesia.
This prospective observational study collected data from 2022 to 2024. All patients were anesthetized according to the department's routine, and predetermined events were recorded. Two commercially available nociception monitors, the PMD-200 from Medasense (NOL) and PainSensor from MedStorm (SCA), were used, and their data were collected along with various hemodynamic parameters. The three nociception monitoring techniques were compared during predetermined events.
A total of 49 patients were included in this study. NOL and SCA demonstrated higher responsiveness than HR for all events except for skin incision. The comparison of the values above and below the threshold for each nociceptive stimulus showed significance for all measurements using the SCA and NOL. However, using HR as a surrogate for nociception with a threshold of a 10% increase from baseline, the difference was significant only at skin incision. There was no variation in the peak values attributable to differences in patients' age. Weight was a significant predictor of the peak NOL values.
NOL and SCA demonstrated superior sensitivity and responsiveness to nociceptive stimuli compared to HR, effectively detecting significant changes in nociceptive thresholds across various stimuli, although responses during skin incision showed no such advantage.
Clinical trial - NCT05218551.
全身麻醉期间伤害性感受控制不足或过度可导致严重不良后果。使用传统临床变量，如心率、收缩压和呼吸频率来评估和管理伤害性反应往往是不够的，可能会导致麻醉药和阿片类药物的过度治疗。本研究评估了三种伤害性感受监测技术，即伤害性感受水平指数（NOL）、皮肤电导痛觉计（SCA）和心率监测在全身麻醉下接受影像引导的微创腹部手术患者中的可行性和有效性。
这项前瞻性观察性研究收集了2022年至2024年的数据。所有患者均按照科室常规进行麻醉，并记录预定事件。使用了两种市售的伤害性感受监测仪，Medasense公司的PMD - 200（NOL）和MedStorm公司的PainSensor（SCA），并收集它们的数据以及各种血流动力学参数。在预定事件期间比较了这三种伤害性感受监测技术。
本研究共纳入49例患者。除皮肤切开外，NOL和SCA在所有事件中均显示出比心率更高的反应性。对每个伤害性刺激阈值上下的值进行比较，结果显示使用SCA和NOL进行的所有测量均具有显著性。然而，以心率作为伤害性感受的替代指标，阈值设定为较基线增加10%，差异仅在皮肤切开时具有显著性。峰值因患者年龄差异无变化。体重是NOL峰值的显著预测因素。
与心率相比，NOL和SCA对伤害性刺激表现出更高的敏感性和反应性，能有效检测各种刺激下伤害性阈值的显著变化，尽管在皮肤切开时的反应没有这种优势。
临床试验 - NCT05218551
