• Rita Saynhalath, Umar H Khan, Gijo Alex, Joseph T Murphy, and Peter Szmuk.
• From the Division of Pediatric Anesthesia, Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas.
• A A Pract. 2021 Nov 2; 15 (11): e01542.

AbstractNociception is the detection of noxious stimulation by the nervous system. The PMD-200 monitor is a validated, emerging technology for intraoperative monitoring using the nociception level (NOL) index. We describe a pediatric case of an open resection of paraganglionic masses during which episodic increases in NOL index and blood pressure coincided with tumor manipulation, presumably due to a catecholamine surge. Since the patient was under stable and adequate analgesia, the increases in NOL index likely reflected the physiologic effects of tumor handling rather that the presence of a true noxious stimulus. Clinicians should consider this limitation when using this monitor.Copyright © 2021 International Anesthesia Research Society.

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