Effectiveness of the Analgesia Nociception Index Monitoring in Patients Who Undergo Colonoscopy with Sedo-Analgesia

Merve Soral, Gülbin Töre Altun, Pelin Çorman Dinçer, Mustafa Kemal Arslantaş, Zuhal Aykaç, Merve Soral, Gülbin Töre Altun, Pelin Çorman Dinçer, Mustafa Kemal Arslantaş, Zuhal Aykaç

Abstract

Objective: The objective of this study was to improve the patient comfort and safety during procedures done under anaesthesia and sedation. The analgesia nociception index (ANI) noninvasively provides information on the nociception-antinociception balance, and it can be used to assess analgesia objectively. We aimed to compare the effects of analgesia management with conventional methods and with ANI monitoring on total opioid consumption, sedation and analgesia levels in patients who underwent colonoscopy using sedo-analgesia.

Methods: Adult patients (n=102), scheduled for procedural sedation, were prospectively analysed. After the induction with propofol and ketamine, infusions of propofol (2 mg kg-1 h-1) and remifentanil (0.05 mcg kg-1 min-1) were started. In Group A, remifentanil infusions were titrated to maintain the ANI value between 50 and 70, whereas in Group C, analgesic requirements were met according to the attending anaesthetist's intention. The heart rate, blood pressure, respiratory rate, SpO2, BIS, Numeric Rating Scale (NRS) and Ramsay Sedation Scale were monitored. Complications, analgesics consumption, duration of the procedure, demographic information, NRS and the Modified Aldrete Score were evaluated.

Results: A total remifentanil amount used in Group A was 66.51±47.87 mcg and 90.15±58.17 mcg in Group C (p=0.011); there was no difference in total amounts of ketamine and propofol given. There was a negative correlation between ANI and NRS scores of Group A patients at Minute 0 at the level of 0.402, which was significant statistically (p=0.003).

Conclusion: Opioid consumption was diminished when ANI monitoring was used, and thus the patient safety was improved. Further studies with longer procedure times and with a greater number of patients are required to demonstrate whether there is a difference in side effects and recovery times.

Keywords: Analgesia nociception index; colonoscopy; sedation; sedo-analgesia.

Conflict of interest statement

Conflict of Interest: The authors have no conflicts of interest to declare.

© Copyright 2020 by Turkish Anaesthesiology and Intensive Care Society.

Figures

Figure 1
Figure 1
Total amount of remifentanil used Values are the mean±standard error of the mean of each Group #P value 0.011 versus control Group.
Figure 2
Figure 2
Heart rate values before and during the procedure
Figure 3
Figure 3
Respiratory rate values before and during the procedure
Figure 4
Figure 4
Mean blood pressure values before and during the procedure (*: p

Figure 5

SpO 2 values before and…

Figure 5

SpO 2 values before and during the procedure (*,¶: p<0.05)

Figure 5
SpO2 values before and during the procedure (*,¶: p<0.05)

Figure 6

BIS values before and during…

Figure 6

BIS values before and during the procedure (*, #, ¶, ., &: p…

Figure 6
BIS values before and during the procedure (*, #, ¶, ., &: p

Figure 7

RSS values during the procedure…

Figure 7

RSS values during the procedure (*, #: p

Figure 7
RSS values during the procedure (*, #: p

Figure 8

NRS values during the procedure…

Figure 8

NRS values during the procedure at Minute 0

Figure 8
NRS values during the procedure at Minute 0

Figure 9

ANI values in Group A…

Figure 9

ANI values in Group A (#: p=0,021, ¶: p=0.049)

Figure 9
ANI values in Group A (#: p=0,021, ¶: p=0.049)

Figure 10

The correlation between NRS and…

Figure 10

The correlation between NRS and ANI values

Figure 10
The correlation between NRS and ANI values
All figures (10)
Similar articles
References
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Figure 5
Figure 5
SpO2 values before and during the procedure (*,¶: p<0.05)
Figure 6
Figure 6
BIS values before and during the procedure (*, #, ¶, ., &: p

Figure 7

RSS values during the procedure…

Figure 7

RSS values during the procedure (*, #: p

Figure 7
RSS values during the procedure (*, #: p

Figure 8

NRS values during the procedure…

Figure 8

NRS values during the procedure at Minute 0

Figure 8
NRS values during the procedure at Minute 0

Figure 9

ANI values in Group A…

Figure 9

ANI values in Group A (#: p=0,021, ¶: p=0.049)

Figure 9
ANI values in Group A (#: p=0,021, ¶: p=0.049)

Figure 10

The correlation between NRS and…

Figure 10

The correlation between NRS and ANI values

Figure 10
The correlation between NRS and ANI values
All figures (10)
Similar articles
References
    1. Van De Velde M, Kuypers M, Teunkens A, Devroe S. Risk and safety of anesthesia outside the operating room. Minerva Anestesiologica. 2009;75:345–8. - PubMed
    1. Chelazzi C, Consales G, Boninsegni P, Bonanomi GA, Castiglione G, De Gaudio AR. Propofol sedation in a colorectal cancer screening outpatient cohort. Minerva Anestesiologica. 2009;75:677–83. - PubMed
    1. World Health Organization. Promoting rational use of medicines: core components. WHO Policy Perspectives on Medicines. No: 005. Sep, 2002. Available from: http://apps.who.int/medicinedocs/pdf/h3011e/h3011e.pdf.
    1. Gruenewald M, Ilies C. Monitoring the nociception-anti-nociception balance. Best Practice & Research Clinical Anaesthesiology. 2013;27:235–47. doi: 10.1016/j.bpa.2013.06.007. - DOI - PubMed
    1. Logier R, Jeanne M, De Jonckheere J, Dassonneville A, Delecroix M, Tavernier B. PhysioDoloris: a monitoring device for analgesia / nociception balance evaluation using heart rate variability analysis. Conference proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society IEEE Engineering in Medicine and Biology Society Annual Conference; 2010 31 August-4 Semptember; Buenos Aires: Argentina. pp. 1194–7. - DOI - PubMed
Show all 27 references
Related information
LinkOut - more resources
Full text links [x]
[x]
Cite
Copy Download .nbib
Format: AMA APA MLA NLM
Figure 7
Figure 7
RSS values during the procedure (*, #: p

Figure 8

NRS values during the procedure…

Figure 8

NRS values during the procedure at Minute 0

Figure 8
NRS values during the procedure at Minute 0

Figure 9

ANI values in Group A…

Figure 9

ANI values in Group A (#: p=0,021, ¶: p=0.049)

Figure 9
ANI values in Group A (#: p=0,021, ¶: p=0.049)

Figure 10

The correlation between NRS and…

Figure 10

The correlation between NRS and ANI values

Figure 10
The correlation between NRS and ANI values
All figures (10)
Figure 8
Figure 8
NRS values during the procedure at Minute 0
Figure 9
Figure 9
ANI values in Group A (#: p=0,021, ¶: p=0.049)
Figure 10
Figure 10
The correlation between NRS and ANI values

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