ORIGINAL ARTICLE   Free access

Minerva Anestesiologica 2018 October;84(10):1160-8

DOI: 10.23736/S0375-9393.18.12720-9

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Validation of the PMD100 and its NOL Index to detect nociception at different infusion regimen of remifentanil in patients under general anesthesia

Pierre-André STÖCKLE ^{1, 2}, Marco JULIEN ¹, Rami ISSA ¹, Elizabeth DÉCARY ¹, Véronique BRULOTTE ¹, Pierre DROLET ¹, Margaret HENRI ³, Madeleine POIRIER ³, Jean-François LATULIPPE ³, Marc DORAIS ⁴, Olivier VERDONCK ¹, Louis-Philippe FORTIER ¹, Philippe RICHEBÉ ¹ ✉

¹ Department of Anesthesiology and Pain Medicine, Maisonneuve-Rosemont Hospital, CIUSSS de l’Est de l’Ile de Montreal, University of Montreal, Montreal, Canada; ² Department of Anesthesiology, University of Bordeaux, Bordeaux University Hospitals, Bordeaux, France; ³ Department of General Surgery of the Maisonneuve-Rosemont Hospital, CIUSSS de l’Est de l’Ile de Montreal, University of Montreal, Montreal, Canada; ⁴ StatSciences Inc., Montreal, Canada

BACKGROUND: The NOL index is based on multiparametric analysis of heart rate (HR), skin conductance, wave plethysmography, and their time derivative. The aim of this study was to evaluate the NOL to detect standardized nociceptive stimuli with various remifentanil dosages under general anesthesia.
METHODS: A prospective, observational study at a single center (NCT02602379) included 40 ASA I to III patients undergoing laparotomy under remifentanil-desflurane anesthesia with epidural analgesia. A tetanic stimulation was applied (forearm) at remifentanil intravenous (IV) infusion of 0.005, 0.05, 0.1, and 0.15 µg/kg/min. NOL and its variations were compared with other parameters namely heart rate, mean arterial pressure, Bispectral Index, and Analgesia Nociception Index (ANI). Receiver operating characteristic (ROC) curves were plotted to assess the response to both intubation and standardized stimulus under remifentanil infusion of 0.005 µg/kg/min.
RESULTS: The post-stimulation NOL values at remifentanil doses of 0.005, 0.05, 0.1 and 0.15 µg/kg/min (39 [23-55], 15 [7-30], 8 [4-14] and 8.5 [4-15]) were significantly higher than pre-stimulation counterparts (P<0.0001). For all other parameters, there was also significant difference between pre- and post-stimulation values at all remifentanil dosages (P<0.0001). Area under the ROC curve (AUC) for the NOL during standardized stimulation was larger than for all other parameters at the exception of ANI (P=0.94). The AUC of NOL for nociception during tracheal intubation was greater (0.93 vs. 0.84 and 0.64 for ANI and HR, respectively).
CONCLUSIONS: NOL monitoring is a promising index to assess the level of nociception in patients under general anesthesia.

KEY WORDS: Nociception - Pain measurement - Remifentanil - General anesthesia