• Can J Anaesth · Sep 2019

    Correlation between incremental remifentanil doses and the Nociception Level (NOL) index response after intraoperative noxious stimuli.

    • Etienne Renaud-Roy, Pierre-André Stöckle, Sarah Maximos, Véronique Brulotte, Lucas Sideris, Pierre Dubé, Pierre Drolet, Issam Tanoubi, Rami Issa, Olivier Verdonck, Louis-Philippe Fortier, and Philippe Richebé.
    • Department of Anesthesiology of Maisonneuve-Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montreal, University of Montreal, 5415 Boulevard de l'Assomption, Montreal, QC, H1T 2M4, Canada.
    • Can J Anaesth. 2019 Sep 1; 66 (9): 1049-1061.

    BackgroundThe Pain Monitoring Device (PMD) monitor (Medasense Biometrics Ltd., Ramat Gan, Israel) uses the Nociception Level (NOL) index, a multiple parameter-derived index that has recently shown a good sensitivity and specificity to detect noxious stimuli. The aim of this study was to assess the latest version of the device (PMD200TM) on variations of the NOL response after standardized tetanic stimuli to study the correlation between remifentanil doses and NOL.MethodsData from 26 patients undergoing midline laparotomy and receiving a desflurane-remifentanil-based anesthetic coupled with low thoracic epidural analgesia were analyzed. A standardized tetanic stimulus was applied to the forearm of the patients at different remifentanil infusion rates. The primary aim was to evaluate the correlation between post-tetanic stimulation NOL values from the PMD200 and remifentanil doses. The NOL index variations after experimental and clinical stimuli were also compared with heart rate (HR), mean arterial pressure (MAP), and Bispectral Index™ (BIS).ResultsA correlation between post-tetanic stimulation NOL values and remifentanil doses was found (r = -0.56; 95% confidence interval [CI], -0.70 to -0.44; P < 0.001). The NOL discriminated noxious from non-noxious states with the maximal Youden's index value of the NOL receiver operating characteristic (ROC) curve showing a specificity of 88% (95% CI, 69.0 to 100) and sensitivity of 79.1% (95% CI, 56.2 to 95.5). The area under the NOL ROC curve (AUC, 0.9; 95% CI, 0.84 to 0.95) was significantly different from the other variables (P < 0.001 vs HR; P < 0.001 vs MAP; P < 0.001 vs BIS).ConclusionsThe NOL value after noxious stimulus decreased with incremental remifentanil doses, showing a significant inverse correlation between the NOL index and opioid doses. The sensitivity and specificity of NOL to discriminate between noxious and non-noxious stimuli suggests its interesting potential as a monitor of nociception intensity during anesthesia.Trial Registrationwww.clinicaltrials.gov (NCT02884778); 27 July, 2016.

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