Newborn infant parasympathetic evaluation (NIPE) as a predictor of hemodynamic response in children younger than 2 years under general anesthesia: an observational pilot study

Kan Zhang,Kan Zhang,Jijian Zheng,Jijian Zheng,Siyuan Wang,Yun’An Song,Lei Wu,Lei Wu,Meihua Cai,Mazhong Zhang,Mazhong Zhang

doi:10.1186/s12871-019-0774-y

Abstract

BackgroundIt is still unknown whether newborn infant parasympathetic evaluation (NIPE), based on heart rate variability (HRV) as a reflection of parasympathetic nerve tone, can predict the hemodynamic response to a nociception stimulus in children less than 2 years old.MethodsFifty-five children undergoing elective surgery were analyzed in this prospective observational study. Noninvasive mean blood pressure (MBP), heart rate (HR) and NIPE values were recorded just before and 1 min after general anesthesia with endotracheal intubation as well as skin incision. The predictive performance of NIPE was evaluated by receiver-operating characteristic (ROC) curve analysis. A significant hemodynamic response was defined by a > 20% increase in HR and/or MBP.ResultsEndotracheal intubation and skin incision caused HR increases of 22.2% (95% confidence interval [CI] 17.5–26.9%) and 3.8% (2.1–5.5%), MBP increases of 18.2% (12.0–24.4%) and 10.6% (7.7–13.4%), and conversely, NIPE decreases of 9.9% (5.3–14.4%) and 5.6% (2.1–9.1%), respectively (all P < 0.01 vs. pre-event value). Positive hemodynamic responses were observed in 32 patients (62.7%) during tracheal intubation and 13 patients (23.6%) during skin incision. The area under the ROC curve values for the ability of NIPE to predict positive hemodynamic responses at endotracheal intubation and skin incision were 0.65 (0.50–0.78) and 0.58 (0.44–0.71), respectively.ConclusionsNIPE reflected nociceptive events as well as anesthestic induction in children less than 2 years undergoing general anaesthetia. Nevertheless, NIPE may not serve as a sensitive and specific predictor to changes in hemodynamics.Trial registrationThis study was registered on May 3, 2018 in the Chinese Clinical Trail Registry; the registration number is (ChiCTR1800015973).

Highlights

It is still unknown whether newborn infant parasympathetic evaluation (NIPE), based on heart rate variability (HRV) as a reflection of parasympathetic nerve tone, can predict the hemodynamic response to a nociception stimulus in children less than 2 years old
Endotracheal intubation and skin incision are two of the strongest noxious stimuli received by surgical patients under general anesthesia [1]
Due to a lack of reliable tools for predicting and assessing the balance between analgesia and nociception during general anesthesia, clinicians mainly use classical symptoms of insufficient analgesia including increases in heart rate (HR), blood pressure, lacrimation, and sweating to tailor the administration of analgesic drugs, an approach that can reduce the side-effects of opioid overdosage but not underdosage [1, 4]

Summary

Introduction

It is still unknown whether newborn infant parasympathetic evaluation (NIPE), based on heart rate variability (HRV) as a reflection of parasympathetic nerve tone, can predict the hemodynamic response to a nociception stimulus in children less than 2 years old. Sufficient analgesic levels are critical to avoid unexpected movements, sympathetic reactions with consequent cardiovascular complications, and the development of pain memory. From another perspective, restriction to a minimum dosage of analgesic is desirable to avoid opioid-induced hyperalgesia, respiratory depression, and nausea as well as to achieve a shorter perioperative treatment period [2, 3]. The NIPE was significantly reduced in babies borned by instrument-assisted delivery when compared to those delivered naturally [9]

Methods

Results

Conclusion