Evaluation of the analgesia nociception index for monitoring intraoperative analgesia in children
Evaluation of the analgesia nociception index for monitoring intraoperative analgesia in children
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DOI：
10.1016/j.bja.2018.03.034
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发表时间：
2018-08-01
影响因子：
9.8
通讯作者：
Dahmani, S.
中科院分区：
文献类型：
--
作者：
Julien-Marsollier, F.;Rachdi, K.;Dahmani, S.
背景：术中镇痛仍然在没有指导的情况下进行。麻醉师根据平均人群阿片类药物药理学研究和血液动力学状态的变化决定给药。然而，这些技术已被证明是不精确的。我们评估的诊断价值，监测镇痛伤害性感受指数（ANI），以检测手术stimulation in children.Methods：这是一项观察性研究，2- 12岁的患者5分钟前和手术切口后。催眠维持七氟烷和指导脑电双频指数。术中镇痛作为瑞芬太尼输注滴定到血液动力学参数的变化，并记录ANI监测值。评估的ANI参数包括瞬时ANI（ANIi）、平均ANI（ANIm）和ANIi与ANIm的相对变化（Δ ANI =ANIi-ANIm/ANIm）。使用受试者操作特征分析进行统计分析，确定受试者操作特征（AUROC）曲线下面积和灰色区域。ANIi、ANIm和DeltaANI的AUROC分别为0.755（0.738-0.772）、0.771（0.755-0.787）和0.756（0.738-0.774）。指示存在有害手术刺激的ANI参数阈值为
Background: Intraoperative analgesia is still administered without guidance. Anaesthetists decide upon dosing on the basis of mean population opioid pharmacological studies and in response to variations in haemodynamic status. However, those techniques have been shown to be imprecise. We assessed the diagnostic value of monitoring the analgesia nociception index (ANI) to detect surgical stimulation in children.Methods: This was an observational study of 2-to 12-yr-old patients 5 min before and after surgical incision. Hypnosis was maintained with sevoflurane and guided by bispectral index. Intraoperative analgesia was administered as a remifentanil infusion titrated to variations in haemodynamic parameters, and ANI monitor values were recorded. ANI parameters assessed included instantaneous ANI (ANIi), mean ANI (ANIm), and the relative change of ANIi to ANIm (DeltaANI=ANIi-ANIm/ANIm). Statistical analyses were performed using receiver-operating-characteristic analysis with determination of the area under the receiver operating characteristic (AUROC) curve and the grey zone.Results: Overall, 49 subjects were included in this study. The AUROC was 0.755 (0.738-0.772), 0.771 (0.755-0.787), and 0.756 (0.738-0.774) for ANIi, ANIm, and DeltaANI, respectively. The threshold of ANI parameters indicating the presence of noxious surgical stimuli was