The heart rate variability-derived Newborn Infant Parasympathetic Evaluation (NIPE™) Index in pediatric surgical patients from 0 to 2 years under sevoflurane anesthesia-A prospective observational pilot study

Frank Weber, Hilde G Roeleveld, Noortje J E Geerts, Annejet T Warmenhoven, Rosalie Schröder, Thomas G de Leeuw, Frank Weber, Hilde G Roeleveld, Noortje J E Geerts, Annejet T Warmenhoven, Rosalie Schröder, Thomas G de Leeuw

Abstract

Background: The heart rate variability-derived Newborn Infant Parasympathetic Evaluation (NIPE™) Index is a continuous noninvasive tool to assess pain and discomfort in infants <2 years. Initial studies focused on pain monitoring in the neonatal intensive care unit environment.

Aims: The aim of this study was to investigate the performance of the NIPE in infants under sevoflurane anesthesia. The primary objective of this study was to compare the NIPE and heart rate as tools to help recognize the need for additional opioid drugs. Secondary objectives were the course of the NIPE and heart rate around specific standardized noxious procedural mile-stones.

Methods: NIPE and heart rate values recorded during a 120 seconds interval before the anesthetist's decision to administer additional opioid due to the perceived insufficient antinociception and during a 120 seconds interval after drug administration were analyzed by means of a repeated measures ANOVA. The same analyses were performed for datasets around per protocol administration of morphine for postoperative analgesia, performance of a caudal block and surgical incision.

Results: In patients with a NIPE value <50, an additional opioid drug administration resulted in a rise of NIPE values, reaching a maximum increase of 5.1 (95% CI: 0.22-9.99) units 120 seconds after drug administration (P = 0.041). There was no evidence of a change in heart rate during these two 120 seconds periods. Per protocol administration of morphine, caudal block, and surgical incision did not result in changes of the NIPE, which was around 65 units on these occasions, and heart rate.

Conclusion: In infants anesthetized with sevoflurane, NIPE values <50 might be indicative of insufficient antinociception. The results of this observational pilot study might suggest that the NIPE could be a better measure of the nociception/antinociception balance than heart rate.

Keywords: general anesthesia; infant; monitors; pain.

Conflict of interest statement

No conflict of interest declared.

© 2019 The Authors. Pediatric Anesthesia Published by John Wiley & Sons Ltd.

Figures

Figure 1
Figure 1
Course of the Newborn Infant Parasympathetic Evaluation Index (NIPE) and heart rate (HR) before and after iv opioid drug administration associated with NIPE‐values http://wileyonlinelibrary.com]
Figure 2
Figure 2
Course of the Newborn Infant Parasympathetic Evaluation Index (NIPE) and heart rate (HR) after per‐protocol administration of iv morphine for postoperative analgesia; (n = 9). Data are presented as mean ± SD [Color figure can be viewed at http://wileyonlinelibrary.com]
Figure 3
Figure 3
Course of the Newborn Infant Parasympathetic Evaluation Index (NIPE) and heart rate (HR) before and after caudal block (left) and surgical incision (right); (n = 21). Data are presented as mean ± SD [Color figure can be viewed at http://wileyonlinelibrary.com]

References

    1. Daccache G, Jeanne M, Fletcher D. The analgesia nociception index: tailoring opioid administration. Anesth Analg. 2017;125:15‐17.
    1. Gruenewald M, Ilies C. Monitoring the nociception‐anti‐nociception balance. Best Pract Res Clin Anaesthesiol. 2013;27:235‐247.
    1. Migeon A, Desgranges F‐P, Chassard D, et al. Pupillary reflex dilatation and analgesia nociception index monitoring to assess the effectiveness of regional anesthesia in children anesthetised with sevoflurane. Pediatr Anesth. 2013;23:1160‐1165.
    1. Sabourdin N, Arnaout M, Louvet N, Guye M‐L, Piana F, Constant I. Pain monitoring in anesthetized children: first assessment of skin conductance and analgesia‐nociception index at different infusion rates of remifentanil. Pediatr Anesth. 2013;23:149‐155.
    1. Weber F, Geerts N, Roeleveld Hg, Warmenhoven At, Liebrand Ca. The predictive value of the heart rate variability‐derived analgesia nociception index in children anaesthetized with sevoflurane: an observational pilot study. Eur J Pain. 2018;22:1597‐1605.
    1. Boselli E, Bouvet L, Begou G, et al. Prediction of hemodynamic reactivity during total intravenous anesthesia for suspension laryngoscopy using analgesia/nociception index (ANI): a prospective observational study. Minerva Anestesiol. 2015;81:288‐297.
    1. Gruenewald M, Herz J, Schoenherr T, et al. Measurement of the nociceptive balance by analgesia nociception index and surgical pleth index during sevoflurane‐remifentanil anesthesia. Minerva Anestesiol. 2015;81:480‐489.
    1. Gruenewald M, Ilies C, Herz J, et al. Influence of nociceptive stimulation on analgesia nociception index (ANI) during propofol‐remifentanil anaesthesia. Br J Anaesth. 2013;110:1024‐1030.
    1. Butruille L, De jonckheere J, Marcilly R, et al. Development of a pain monitoring device focused on newborn infant applications: The NeoDoloris project. IRBM. 2015;36:80‐85.
    1. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61:344‐349.
    1. Mdoloris Medical Systems . Newborn Infant Parasymathetic Evaluation (NIPE) Product Brochure (Website). August 07, 2018. . Accessed August 7, 2018.
    1. De Jonckheere J, Rakza T, Logier R, et al. Heart rate variability analysis for newborn infants prolonged pain assessment. Conf Proc IEEE Eng Med Biol Soc. 2011;2011:7747‐7750.
    1. Faye PM, De Jonckheere J, Logier R, et al. Newborn infant pain assessment using heart rate variability analysis. Clin J Pain. 2010;26:777‐782.
    1. Cremillieux C, Makhlouf A, Pichot V, Trombert B, Patural H. Objective assessment of induced acute pain in neonatology with the newborn infant parasympathetic evaluation index. Eur J Pain. 2018;22:1071‐1079.
    1. Tanaka M, Nishikawa T. Arterial baroreflex function in humans anaesthetized with sevoflurane. Br J Anaesth. 1999;82:350‐354.
    1. Kanaya N, Hirata N, Kurosawa S, Nakayama M, Namiki A. Differential effects of propofol and sevoflurane on heart rate variability. Anesthesiology. 2003;98:34‐40.
    1. Cardoso S, Silva MJ, Guimaraes H. Autonomic nervous system in newborns: a review based on heart rate variability. Childs Nerv Syst. 2017;33:1053‐1063.
    1. Javorka K, Lehotska Z, Kozar M, et al. Heart rate variability in newborns. Physiol Res. 2017;66:S203‐S214.

Source: PubMed

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