Clinical value of analgesia/nociception index in evaluating analgesic effect during lobectomy performed via video-assisted thoracoscope

Abstract

Objective To primarily investigate the clinical value of analgesia/nociception index (ANI) in evaluating the analgesic effect during lobectomy performed via video-assisted thoracoscope.Methods Forty ASA physical status Ⅰ or Ⅱ patients,aged 25-64 yr,weighing 45-80 kg,undergoing elective lobectomy performed via video-assisted thoracoscope,were enrolled in this study.After induction of anesthesia with propofol,sufentanil and cisatracurium,patients received double lumen endotracheal intubation.Anesthesia was maintained with targetcontrolled infusion of propofol,and iv infusion of remifentanil and cisatracurium.The concentration of propofol was adjusted to maintain the bispectral index (BIS) value in the range of 40-60.ANI,HR,systolic blood pressure (SBP),diastolic blood pressure (DBP) and BIS value were recorded within 5 min before and after the predefined time points including posture change between lateral and supine position,ventilatory pattern change between onelung and double-lung ventilation,skin incision and trocars insertion,lymph node dissection and pleural lavage.At skin incision and during trocars insertion,lymph node dissection and pleural lavage,the development of hemodynamic responses (increase in HR and SBP ＞ 20％ of baseline value) were recorded.Results The incidence of hemodynamic responses was 100％ at skin incision and trocars insertion,and 84 ％ during No.4,7,10 groups of lymph node dissection and after pleural lavage and difference was found in ANI during these stimuli.ANI was significantly decreased within 5 min after skin incision,trocars insertion,No.4,7,10 groups of lymph node dissection and pleural lavage than that before the procedures (P ＜ 0.05).The BIS value was maintained at 40-60,and no significant changes were found between before and after the procedures (P ＞ 0.05).No significant changes were found in ANI,HR,SBP,and DBP between before and after the changes of posture and respiratory pattern (P ＞ 0.05).Conclusion ANI can be used to evaluate the analgesic effect during lobectomy performed via video-assisted thoracoscope in patients and is unaffected by the changes of posture and ventilatory pattern. Key words: Analgesia; Thoracoscopy; Nociceptors