Multimodal monitoring using the Analgesia Nociception Index (ANI) during catheter ablation of the heart in patients with sinus rhythm and short-term induced atrial arrhythmia: prospective observational study

Abstract

INTRODUCTION: Сatheter ablation (CA) is a painful procedure requiring an assessment of the balance between nociception associated with surgical trauma and anesthesia induced antinociception. OBJECTIVE: To evaluate the effectiveness of the monitoring system “ANI Monitor” for anesthesia and intensive care in patients with sinus rhythm and short-term induced (< 1 min) atrial arrhythmia (STIAA). MATERIALS AND METHODS: The study group of our trial consisted of 94 patients with CA and ANI Monitor. The control group consisted of 94 patients, selected using the “copy-pair” method, with standard (hemodynamic) monitoring. A Numerical Rating Scale (NRS) was used for assessment the intensity of pain. At the stage of femoral vein catheterization in all patients regional anesthesia was performed, at the CA stage, procedural sedation and/or analgesia (PSA) was titrated with the administration of propofol and fentanyl (under the control with ANI Monitor). Statistical data processing was carried out using Statistica 10.0 and SPSS programs. RESULTS: At the stage of CA under PSA, negative correlation was found between NRS and ANIm in patients with sinus rhythm and STIAA (r = −0.37). At the threshold of 56.0 the sensitivity and specificity of ANIm in detecting NRS ˃ 3 were 60 and 100 %, respectively, corresponding to ROC curve AUC of 0.81. Significant changes in hemodynamic reactivity were not registered. It was revealed the reduction of fentanyl administration in patients of the study group (0.04 ± 0.02 and 0.05 ± 0.03 µg/kg/min, respectively, p < 0.001) under the control of ANI Monitor. CONCLUSIONS: ANI Monitor during CA in patients with sinus rhythm and STIAA was more effective in detecting harmful nociceptive stimuli compared to standard (hemodynamic) monitoring. The use of ANI Monitor to control the fentanyl administration could create conditions for opioid-sparing anesthesia.