Количественный интраоперационный мониторинг анальгезии

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Основными компонентами общей анестезии являются угнетение сознания, обезболивание и миорелаксация. В течение последнего десятилетия разработаны различные системы мониторинга для количественной оценки обезболивания во время операции. Наибольшее распространение получили методики, основанные на анализе изменяющейся в ответ на ноцицептивную стимуляцию активности вегетативной нервной системы. Это изменение вариабельности сердечного ритма и амплитуды пульсовой волны, кожной проводимости, а также реакции зрачка, которая оценивается с помощью пупиллометрии. Несмотря на то, что данные методы обладают определенными ограничениями и не получили пока широкого распространения в клинической практике, количественный интраоперационный мониторинг анальгезии становится перспективным направлением для исследований.

Ключевые слова:

боль

анальгезия

ноцицепция

вегетативная нервная система

интраоперационный мониторинг

общая анестезия

опиоидные анальгетики

Авторы:

Тарасова Н.Ю.

ФГАУ «Национальный медицинский исследовательский центр нейрохирургии им. акад. Н.Н. Бурденко» Минздрава России, Москва, Россия

Шмигельский А.В.

ФГБУ "НИИ нейрохирургии им. акад. Н.Н. Бурденко" РАМН, Москва

Лубнин А.Ю.

ГБУЗ МО «Московский областной научно-исследовательский институт акушерства и гинекологии», Москва, Россия, ФГБНУ НИИ нейрохирургии им. Н.Н. Бурденко (дир. — акад. РАН А.А. Потапов), Москва, Россия, Кафедра акушерства и гинекологии ФУВ ГБУЗ МО «Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского», Москва, Россия

Куликов А.С.

Список литературы:

Gan TJ, Habib AS, Miller TE, White W, Apfelbaum JL. Incidence, patient satisfaction, and perceptions of post-surgical pain: results from a US national survey. Current Medical Research and Opinion. 2014;30(1):149-160. https://doi.org/10.1185/03007995.2013.860019
Hah JM, Bateman BT, Ratliff J, Curtin C, Sun E. Chronic Opioid Use after Surgery: Implications for Perioperative Management in the Face of the Opioid Epidemic. Anesthesia and Analgesia. 2017;125(5):1733-1740. https://doi.org/10.1213/ANE.0000000000002458
Apfel CC, Heidrich FM, Jukar-Rao S, Jalota L, Hornuss C, Whelan RP, Zhang K, Cakmakkaya OS. Evidence-based analysis of risk factors for postoperative nausea and vomiting. British Journal of Anaesthesia. 2012;109(5):742-753. https://doi.org/10.1093/bja/aes276
Boyer EW. Management of Opioid Analgesic Overdose. New England Journal of Medicine. 2012;367(2):146-155. https://doi.org/10.1056/NEJMra1202561
Fletcher D, Martinez V. Opioid-induced hyperalgesia in patients after surgery: A systematic review and a meta-analysis. British Journal of Anaesthesia. 2014;112(6):991-1004. https://doi.org/10.1093/bja/aeu137
Bonica JJ. The need of taxonomy. Pain. 1979;6(3):247-248.
Basbaum AI, Bautista DM, Scherrer G, Julius D, Murugan R, Manuscript A. Cellular and Molecular Mechanisms of Pain. Cell. 2009;139(2):267-284. https://doi.org/10.1016/j.cell.2009.09.028
Almeida TF, Roizenblatt S, Tufik S. Afferent pain pathways: A neuroanatomical review. Brain Research. 2004;1000(1-2):40-56. https://doi.org/10.1016/j.brainres.2003.10.073
Crockett A, Panickar A. Role of the sympathetic nervous system in pain. Anaesthesia and Intensive Care Medicine. 2011;12(2):50-54. https://doi.org/10.1016/j.mpaic.2010.10.023
Bantel C, Trapp S. The role of the autonomic nervous system in acute surgical pain processing — what do we know? Anaesthesia. 2011;66(7):541-544. https://doi.org/10.1111/j.1365-2044.2011.06791.x
Schlereth T, Birklein F. The sympathetic nervous system and pain. Neuro Molecular Medicine. 2008;10:141-147. https://doi.org/10.1007/s12017-007-8018-6
Cividjian A, Petitjeans F, Liu N, Ghignone M, de Kock M, Quintin L. Do we feel pain during anesthesia? A critical review on surgery-evoked circulatory changes and pain perception. Best Practice and Research. Clinical Anaesthesiology. 2017;31(4):445-467. https://doi.org/10.1016/j.bpa.2017.05.001
Daoust R, Paquet J, Bailey B, Lavigne G, Piette É, Sanogo K, Chauny JM. Vital signs are not associated with self-reported acute pain intensity in the emergency department. CJEM: Canadian Journal of Emergency Medical Care. 2016;18(1):19-27. https://doi.org/10.1017/cem.2015.21
Cowen R, Stasiowska MK, Laycock H, Bantel C. Assessing pain objectively: The use of physiological markers. Anaesthesia. 2015;70(7):828-847. https://doi.org/10.1111/anae.13018
Taralov ZZ, Terziyski KV, Kostianev SS. Heart Rate Variability as a Method for Assessment of the Autonomic Nervous System and the Adaptations to Different Physiological and Pathological Conditions. Folia Medica. 2015;57:173-180. https://doi.org/10.1515/folmed-2015-0036
Jeanne M, Logier R, De Jonckheere JBT. Heart rate variability during total intravenous anesthesia: Effects of nociception and analgesia. Autonomic Neuroscience: Basic and Clinical. 2009;147(1-2):91-96. https://doi.org/10.1016/j.autneu.2009.01.005
Баевский Р.М. Анализ вариабельности сердечного ритма: история и философия, теория и практика. Клиническая информатика и телемедицина. 2004;1:54-64.
De Jonckheere J, Bonhomme V, Jeanne M, Boselli E, Gruenewald M, Logier R, Richebé P. Physiological Signal Processing for Individualized Anti-nociception Management During General Anesthesia: a Review. Yearbook of Medical Informatics. 2015;10(1):95-101. https://doi.org/10.15265/IY-2015-004/
Gruenewald M, Ilies C, Herz J, Schoenherr T, Fudickar A, Höcker J, Bein B. Influence of nociceptive stimulation on analgesia nociception index (ANI) during propofol-remifentanil anaesthesia. British Journal of Anaesthesia. 2013;110(8):1024-1030. https://doi.org/10.1093/bja/aet019
Jeanne M, Clément C, De Jonckheere J, Logier R, Tavernier B. Variations of the analgesia nociception index during general anaesthesia for laparoscopic abdominal surgery. Journal of Clinical Monitoring and Computing. 2012;26(4):289-294. https://doi.org/10.1007/s10877-012-9354-0
Gruenewald M, Herz J, Schoenherr T, Thee C, Steinfath M, Bein B. Measurement of the nociceptive balance by analgesia nociception index and surgical pleth index during sevoflurane-remifentanil anesthesia. Minerva Anestesiologica. 2015;81:480-489.
Turan G, Ar AY, Kuplay YY, Demiroluk O, Gazi M, Akgun N, Celikoglu E. Analgesia Nociception Index for perioperative analgesia monitoring in spinal surgery. Brazilian Journal of Anesthesiology. 2017;67(4):370-375. https://doi.org/10.1016/j.bjan.2017.03.004
Kommula LK, Bansal S, Umamaheswara Rao GS. Analgesia Nociception Index Monitoring During Supratentorial Craniotomy. Journal of Neurosurgical Anesthesiology. 2019;31(1):57-61. https://doi.org/10.1097/ANA.0000000000000464
Upton HD, Ludbrook GL, Wing A, Sleigh JW. Intraoperative «analgesia nociception index» — guided fentanyl administration during sevoflurane anesthesia in lumbar discectomy and laminectomy: A randomized clinical trial. Anesthesia and Analgesia. 2017;125(1):81-90. https://doi.org/10.1213/ANE.0000000000001984
Szental JA, Webb A, Weeraratne C, Campbell A, Sivakumar H, Leong S. Postoperative pain after laparoscopic cholecystectomy is not reduced by intraoperative analgesia guided by analgesia nociception index (ANI) monitoring: A randomized clinical trial. British Journal of Anaesthesia. 2015;114(4):640-645. https://doi.org/10.1093/bja/aeu411
Bollag L, Ortner CM, Jelacic S, Rivat C, Landau R, Richebé P. The effects of low-dose ketamine on the analgesia nociception index (ANI) measured with the novel PhysioDolorisTM analgesia monitor: a pilot study. Journal of Clinical Monitoring and Computing. 2015;29(2):291-295. https://doi.org/10.1007/s10877-014-9600-8
De Jonckheere J, Rakza T, Logier R, Jeanne M, Jounwaz R, Storme L. Heart rate variability analysis for newborn infants prolonged pain assessment. Conference proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society. 2011;7747-7750. https://doi.org/10.1109/IEMBS.2011.6091909
Waxman JA, Riddell RRP, Tablon P, Schmidt LA, Pinhasov A. Development of Cardiovascular indices of acute pain responding in infants: A systematic review. Pain Research and Management. 2016;8458696. https://doi.org/10.1155/2016/8458696
Boselli E, Logier R, Bouvet L, Allaouchiche B. Prediction of hemodynamic reactivity using dynamic variations of Analgesia/Nociception Index (∆ANI). Journal of Clinical Monitoring and Computing. 2016;30(6):977-984. https://doi.org/10.1007/s10877-015-9802-8
Talke P. The effect of tracheal intubation-induced autonomic response on photoplethysmography. Anesthesiology Research and Practice. 2017;7646541. https://doi.org/10.1155/2017/7646541
Huiku M, Uutela K, van Gils M, Korhonen I, Kymäläinen M, Meriläinen P, Paloheimo M, Rantanen M, Takala P, Viertiö-Oja H, Yli-Hankala A. Assessment of surgical stress during general anaesthesia. British Journal of Anaesthesia. 2007;98(4):447-455. https://doi.org/10.1093/bja/aem004
Bonhomme V, Uutela K, Hans G, Maquoi I, Born JD, Brichant JF, Lamy M, Hans P. Comparison of the Surgical Pleth IndexTM with haemodynamic variables to assess nociception-anti-nociception balance during general anaesthesia. British Journal of Anaesthesia. 2011;106(1):101-111. https://doi.org/10.1093/bja/aeq291
Gruenewald M, Meybohm P, Ilies C, Höcker J, Hanss R, Scholz J, Bein B. Influence of different remifentanil concentrations on the performance of the surgical stress index to detect a standardized painful stimulus during sevoflurane anaesthesia. British Journal of Anaesthesia. 2009;103(4):586-593. https://doi.org/10.1093/bja/aep206
Chen X, Thee C, Gruenewald M, Wnent J, Illies C, Hoecker J, Hanss R, Steinfath M, Bein B. Comparison of surgical stress index-guided analgesia with standard clinical practice during routine general anesthesia: A pilot study. Anesthesiology. 2010;112(5):1175-1183. https://doi.org/10.1097/ALN.0b013e3181d3d641
Won YJ, Lim BG, Kim YS, Lee M, Kim H. Usefulness of surgical pleth index-guided analgesia during general anesthesia: a systematic review and meta-analysis of randomized controlled trials. Journal of International Medical Research. 2018;46(11):4386-4398. https://doi.org/10.1177/0300060518796749
Ahonen J, Jokela R, Uutela K, Huiku M. Surgical stress index reflects surgical stress in gynaecological laparoscopic day-case surgery. British Journal of Anaesthesia. 2007;98(4):456-461. https://doi.org/10.1093/bja/aem035
Won YJ, Lim BG, Yeo GE, Lee MK, Lee DK, Kim H, Lee IO, Kong MH. The effect of nicardipine on the surgical pleth index during thyroidectomy under general anesthesia: A prospective double-blind randomized controlled trial. Medicine (Baltimore). 2017;96(6):6154. https://doi.org/10.1097/MD.0000000000006154
Yang YL, Seok HS, Noh GJ, Choi BM, Shin H. Postoperative pain assessment indices based on photoplethysmography waveform analysis. Frontiers in Physiolology. 2018;9:1-11. https://doi.org/10.3389/fphys.2018.01199
Storm H. Changes in skin conductance as a tool to monitor nociceptive stimulation and pain. Current Opinion in Anaesthesiology. 2008;21(6):796-804. https://doi.org/10.1097/ACO.0b013e3283183fe4
Storm H, Støen R, Klepstad P, Skorpen F, Qvigstad E, Raeder J. Nociceptive stimuli responses at different levels of general anaesthesia and genetic variability. Acta Anaesthesiologica Scandinavica. 2013;57(1):89-99. https://doi.org/10.1111/aas.12017
Ledowski T, Pascoe E, Ang B, Schmarbeck T, Clarke MW, Fuller C, Kapoor V. Monitoring of intra-operative nociception: Skin conductance and surgical stress index versus stress hormone plasma levels. Anaesthesia. 2010;65(10):1001-1006. https://doi.org/10.1111/j.1365-2044.2010.06480.x
Ledowski T, Preuss J, Schug SA. The effects of neostigmine and glycopyrrolate on skin conductance as a measure of pain. European Journal of Anaesthesiolology. 2009;26(9):777-781. https://doi.org/10.1097/EJA.0b013e32832bb678
Valkenburg AJ, Niehof SP, Van Dijk M, Verhaar EJM, Tibboel D. Skin conductance peaks could result from changes in vital parameters unrelated to pain. Pediatric Research. 2012;71(4 Pt 1):375-379. https://doi.org/10.1038/pr.2011.72
Tronstad C, KalvØy H, Grimnes S, Martinsen ØG. Waveform difference between skin conductance and skin potential responses in relation to electrical and evaporative properties of skin. Psychophysiology. 2013;50(11):1070-1078. https://doi.org/10.1111/psyp.12092
Sabourdin N, Arnaout M, Louvet N, Guye ML, Piana F, Constant I. Pain monitoring in anesthetized children: First assessment of skin conductance and analgesia-nociception index at different infusion rates of remifentanil. Pediatric Anesthesia. 2013;23(2):149-155. https://doi.org/10.1111/pan.12071
van der Lee R, Jebbink LJG, van Herpen THM, d’Haens EJ, Bierhuizen J, van Lingen RA. Feasibility of monitoring stress using skin conduction measurements during intubation of newborns. European Journal of Pediatrics. 2016;175:237-243. https://doi.org/10.1007/s00431-015-2621-6
Jildenstal P, Hallén K, Almskog K, Sand J, Stomberg MW. Monitoring the Nociception Level Intraoperatively — An Initial Experiences. Journal of Anaesthesia and Intensive Care Medicine. 2018;7:555709. https://doi.org/10.19080/JAICM.2018.07.555709
Ben-Israel N, Kliger M, Zuckerman G, Katz Y, Edry R. Monitoring the nociception level: A multi-parameter approach. Journal of Clinical Monitoring and Computing. 2013;27(6):659-668. https://doi.org/10.1007/s10877-013-9487-9
Bollag L, Jelacic S, Delgado Upegui C, Wu C, Richebe P. The nociception level index (NOL) response to intubation and incision in patients undergoing video-assisted thoracoscopic surgery (VATS) with and without thoracic epidural analgesia. A pilot study. F1000Research. 2018;7:875. https://doi.org/10.12688/f1000research.15279.1
Edry R, Recea V, Dikust Yu, Sessler DI. Preliminary Intraoperative Validation of the Nociception Level Index. Anesthesiology. 2016;125(1):193-203. https://doi.org/10.1097/ALN.0000000000001130
Stöckle PA, Julien M, Issa R, Décary E, Brulotte V, Drolet P, Henri M, Poirier M, Latulippe F, Dorais M, Verdonck O, Fortier LP. Validation of the PMD100 and its NOL Index to detect nociception at different infusion regimen of remifentanil in patients under general anesthesia. Minerva Anestesiologica. 2018;84(10):1160-1168. https://doi.org/10.23736/S0375-9393.18.12720-9
McDougal DH, Gamlin PD. Autonomic control of the eye. Comprehensive Physiology. 2015;5(1):439-473. https://doi.org/10.1002/cphy.c140014
Larson MD, Behrends M. Portable infrared pupillometry: A review. Anesthesia and Analgesia. 2015;120(6):1242-1253. https://doi.org/10.1213/ANE.0000000000000314
Jakuscheit A, Weth J, Lichtner G, Jurth C, Rehberg B, Von Dincklage F. Intraoperative monitoring of analgesia using nociceptive reflexes correlates with delayed extubation and immediate postoperative pain: A prospective observational study. European Journal of Anaesthesiolology. 2017;34(5):297-305. https://doi.org/10.1097/EJA.0000000000000597
Sabourdin N, Barrois J, Louvet N, Rigouzzo A, Guye ML, Dadure C, Constant I. Pupillometry-guided Intraoperative Remifentanil Administration versus standart practice influence opioid use: A randomized study. Anesthesiology. 2017;127(2):284-292. https://doi.org/10.1097/ALN.0000000000001705
Constant I, Nghe MC, Boudet L, Berniere J, Schrayer S, Seeman R, Murat I. Reflex pupillary dilatation in response to skin incision and alfentanil in children anaesthetized with sevoflurane: A more sensitive measure of noxious stimulation than the commonly used variables. British Journal of Anaesthesia. 2006;96(5):614-619. https://doi.org/10.1093/bja/ael073
Connelly MA, Brown JT, Kearns GL, Anderson RA, St Peter SD, Neville KA. Pupillometry: a non-invasive technique for pain assessment in paediatric patients. Archives of Disease in Childhood. 2014;99(12):1125-1131. https://doi.org/10.1136/archdischild-2014-306286
Bourgeois E, Sabourdin N, Louvet N, Donette FX, Guye ML, Constant I. Minimal alveolar concentration of sevoflurane inhibiting the reflex pupillary dilatation after noxious stimulation in children and young adults. British Journal of Anaesthesia. 2012;108(4):648-654. https://doi.org/10.1093/bja/aer459
Dualé C, Julien H, Pereira B, Abbal B, Baud C, Schoeffler P. Pupil diameter during postanesthetic recovery is not influenced by postoperative pain, but by the intraoperative opioid treatment. Journal of Clinical Anesthesia. 2015;27(1):23-32. https://doi.org/10.1016/j.jclinane.2014.09.006
Larson MD, Talke PO. Effect of dexmedetomidine, an α2-adrenoceptor agonist, on human pupillary reflexes during general anaesthesia. British Journal of Clinical Pharmacology. 2001;51(1):27-33. https://doi.org/10.1046/j.1365-2125.2001.01311.x

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