Monitoring nociception during general anesthesia with cardiorespiratory coherence
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ORIGINAL RESEARCH
Monitoring nociception during general anesthesia with cardiorespiratory coherence Chris J. Brouse • Walter Karlen • Guy A. Dumont Dorothy Myers • Erin Cooke • Jonathan Stinson • Joanne Lim • J. Mark Ansermino
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Received: 2 November 2012 / Accepted: 26 March 2013 Ó Springer Science+Business Media New York 2013
Abstract A novel wavelet transform cardiorespiratory coherence (WTCRC) algorithm has been developed to measure the autonomic state. WTCRC may be used as a nociception index, ranging from 0 (no nociception, strong coherence) to 100 (strong nociception, low coherence). The aim of this study is to estimate the sensitivity of the algorithm to nociception (dental dam insertions) and antinociception (bolus doses of anesthetic drugs). WTCRC’s sensitivity is compared to mean heart rate (HRmean) and mean non-invasive blood pressure (NIBPmean), which are commonly used clinical signs. Data were collected from 48 children receiving general anesthesia during dental surgery. The times of dental dam insertion and anesthetic bolus events were noted in real-time during surgeries. 42 dental dam insertion and 57 anesthetic bolus events were analyzed. The change in average WTCRC, HRmean, and NIBPmean was calculated between a baseline period before each event and a response period after. A Wilcoxon rank-sum test was used to compare changes. Dental dam insertion changed the WTCRC nociception index by an average of 14 (82 %) [95 % CI from 7.4 to 19], HRmean by 7.3 beats/min (8.1 %) [5.6–9.6], and NIBPmean by 8.3 mmHg (12 %) [4.9–13]. A bolus dose of anesthetics changed the WTCRC by -15 (-50 %) [-21 to -9.3], HRmean by -4.8 beats/min (4.6 %) [-6.6 to -2.9], and NIBPmean by -2.6 mmHg (3.4 %) [-4.7 to -0.50]. A nociception index based on cardiorespiratory coherence is C. J. Brouse (&) W. Karlen G. A. Dumont Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC, Canada e-mail: [email protected] D. Myers E. Cooke J. Stinson J. Lim J. M. Ansermino Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
more sensitive to nociception and antinociception than are HRmean or NIBPmean. The WTCRC algorithm shows promise for noninvasively monitoring nociception during general anesthesia. Keywords Cardiorespiratory coherence Heart rate variability Respiratory sinus arrhythmia Nociception Antinociception Analgesia
1 Introduction Anesthesiology includes the practice of autonomic medicine. Noxious stimuli during surgery cause the autonomic nervous system (ANS) to invoke a stress response, increasing sympathetic tone and decreasing parasympathetic tone [10]. An excessive and prolonged sympathetic response increases the risk of suffering from peri-operative complications, delays recovery, and is a key factor in postoperative morbidity [12]. Anesthesiologists must therefore control the stress response (nociception) by administering analgesic drugs (antinociception). The ANS is currently not routinely mo
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