Title |
Monitoring the nociception level: a multi-parameter approach
|
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Published in |
Journal of Clinical Monitoring and Computing, July 2013
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DOI | 10.1007/s10877-013-9487-9 |
Pubmed ID | |
Authors |
Nir Ben-Israel, Mark Kliger, Galit Zuckerman, Yeshayahu Katz, Ruth Edry |
Abstract |
The aim of the present study was to develop and validate an objective index for nociception level (NoL) of patients under general anesthesia, based on a combination of multiple physiological parameters. Twenty-five patients scheduled for elective surgery were enrolled. For clinical reference of NoL, the combined index of stimulus and analgesia was defined as a composite of the surgical stimulus level and a scaled effect-site concentration of opioid. The physiological parameters heart rate, heart rate variability (0.15-0.4 Hz band power), plethysmograph wave amplitude, skin conductance level, number of skin conductance fluctuations, and their time derivatives, were extracted. Two techniques to incorporate these parameters into a single index representing the NoL have been proposed: NoLlinear, based on an ordinary linear regression, and NoLnon-linear, based on a non-linear Random Forest regression. NoLlinear and NoLnon-linear significantly increased after moderate to severe noxious stimuli (Wilcoxon rank test, p < 0.01), while the individual parameters only partially responded. Receiver operating curve analysis showed that NoL index based on both techniques better discriminated noxious and non-noxious surgical events [area under curve (AUC) = 0.97] compared with individual parameters (AUC = 0.56-0.74). NoLnon-linear better ranked the level of nociception compared with NoLlinear (R = 0.88 vs. 0.77, p < 0.01). These results demonstrate the superiority of multi-parametric approach over any individual parameter in the evaluation of nociceptive response. In addition, advanced non-linear technique may have an advantage over ordinary linear regression for computing NoL index. Further research will define the usability of the NoL index as a clinical tool to assess the level of nociception during general anesthesia. |
Mendeley readers
Geographical breakdown
Country | Count | As % |
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United Kingdom | 1 | <1% |
Colombia | 1 | <1% |
Unknown | 170 | 99% |
Demographic breakdown
Readers by professional status | Count | As % |
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Other | 20 | 12% |
Researcher | 19 | 11% |
Student > Doctoral Student | 13 | 8% |
Student > Postgraduate | 12 | 7% |
Other | 35 | 20% |
Unknown | 47 | 27% |
Readers by discipline | Count | As % |
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Computer Science | 16 | 9% |
Agricultural and Biological Sciences | 4 | 2% |
Nursing and Health Professions | 4 | 2% |
Other | 17 | 10% |
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