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Canadian Journal of Anesthesia/Journal canadien d'anesthésie
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie 9/2019

01-09-2019 | Remifentanil | Reports of Original Investigations

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

Authors: Etienne Renaud-Roy, MD, Pierre-André Stöckle, MD, MSc, DESAR, Sarah Maximos, MSc, MD, Véronique Brulotte, MD, MSc, FRCPC, Lucas Sideris, MD, FRCSC, Pierre Dubé, MD, MSc, FRCSC, FACS, Pierre Drolet, MD, FRCPC, Issam Tanoubi, MD, MA(ed), DESAR, Rami Issa, BEng, MD, FRCPC, Olivier Verdonck, MD, MSc, DESAR, Louis-Philippe Fortier, MD, MSc, FRCPC, Philippe Richebé, MD, PhD, DESAR

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 9/2019

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Abstract

Background

The 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.

Methods

Data 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).

Results

A 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).

Conclusions

The 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 registration

www.​clinicaltrials.​gov (NCT 02884778); 27 July, 2016.
Appendix
Available only for authorised users
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Metadata
Title
Correlation between incremental remifentanil doses and the Nociception Level (NOL) index response after intraoperative noxious stimuli
Authors
Etienne Renaud-Roy, MD
Pierre-André Stöckle, MD, MSc, DESAR
Sarah Maximos, MSc, MD
Véronique Brulotte, MD, MSc, FRCPC
Lucas Sideris, MD, FRCSC
Pierre Dubé, MD, MSc, FRCSC, FACS
Pierre Drolet, MD, FRCPC
Issam Tanoubi, MD, MA(ed), DESAR
Rami Issa, BEng, MD, FRCPC
Olivier Verdonck, MD, MSc, DESAR
Louis-Philippe Fortier, MD, MSc, FRCPC
Philippe Richebé, MD, PhD, DESAR
Publication date
01-09-2019
Publisher
Springer International Publishing
Keyword
Remifentanil
Published in
Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 9/2019
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI
https://doi.org/10.1007/s12630-019-01372-1

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