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Accuracy of the composite variability index as a measure of the balance between nociception and, antinociception during anesthesia

(2014) ANESTHESIA AND ANALGESIA. 119(2). p.288-301
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Abstract
BACKGROUND: The Composite Variability Index (CVI), derived from the electroencephalogram, was developed to assess the antinociception-nociception balance, whereas the Bispectral Index (BIS) was developed to assess the hypnotic state during anesthesia. We studied the relationships between these indices, level of hypnosis (BIS level), and antinociception (predicted remifentanil effect-site concentrations, CeREMI) before and after stimulation. Also, we measured their association with movement in response to a noxious stimulus. METHODS: We randomized 120 patients to one of 12 groups targeting different hypnotic levels (BIS 70, 50, and 30) and various CeREMI (0, 2, 4, or 6 ng/mL). At pseudo-steady state, baseline values were observed, and a series of stimuli were applied. Changes in BIS, CVI, heart rate (HR), and mean arterial blood pressure (MAP) between baseline and response period were analyzed in relation to level of hypnosis, antinociception, and somatic response to the stimuli. RESULTS: CVI and BIS more accurately correlate with somatic response to an Observer Assessment of Alertness and Sedation-noxious stimulation than HR, MAP, CeREMI, and propofol effect-site concentration (Tukey post hoc tests P < 0.01). Change in CVI is more adequate to monitor response to stimulation than changes in BIS, HR, or MAP (as described by the Mathews Correlation Coefficient with significance level set at P < 0.001). In contrast, none of the candidate analgesic state indices was uniquely related to a specific opioid concentration and is extensively influenced by the hypnotic state as measured by BIS. CONCLUSIONS: CVI appears to correlate with somatic responses to noxious stimuli. However, unstimulated CVI depends more on hypnotic drug effect than on opioid concentration.
Keywords
Surgical Stress Index, Propofol-Remifentanil Anesthesia, Heart-Rate, General-Anesthesia, Noxious Stimuli, Performance, Depth, Pharmacokinetics, Skin Incision, Bispectral Index

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Citation

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Chicago
Sahinovic, Marco M, Douglas J Eleveld, Alain F Kalmar, Eleonora H Heeremans, Tom De Smet, Chandran V Seshagiri, Anthony R Absalom, HUGO VEREECKE, and Michel Struys. 2014. “Accuracy of the Composite Variability Index as a Measure of the Balance Between Nociception and, Antinociception During Anesthesia.” Anesthesia and Analgesia 119 (2): 288–301.
APA
Sahinovic, Marco M, Eleveld, D. J., Kalmar, A. F., Heeremans, E. H., De Smet, T., Seshagiri, C. V., Absalom, A. R., et al. (2014). Accuracy of the composite variability index as a measure of the balance between nociception and, antinociception during anesthesia. ANESTHESIA AND ANALGESIA, 119(2), 288–301.
Vancouver
1.
Sahinovic MM, Eleveld DJ, Kalmar AF, Heeremans EH, De Smet T, Seshagiri CV, et al. Accuracy of the composite variability index as a measure of the balance between nociception and, antinociception during anesthesia. ANESTHESIA AND ANALGESIA. 2014;119(2):288–301.
MLA
Sahinovic, Marco M, Douglas J Eleveld, Alain F Kalmar, et al. “Accuracy of the Composite Variability Index as a Measure of the Balance Between Nociception and, Antinociception During Anesthesia.” ANESTHESIA AND ANALGESIA 119.2 (2014): 288–301. Print.
@article{5769790,
  abstract     = {BACKGROUND: The Composite Variability Index (CVI), derived from the electroencephalogram, was developed to assess the antinociception-nociception balance, whereas the Bispectral Index (BIS) was developed to assess the hypnotic state during anesthesia. We studied the relationships between these indices, level of hypnosis (BIS level), and antinociception (predicted remifentanil effect-site concentrations, CeREMI) before and after stimulation. Also, we measured their association with movement in response to a noxious stimulus. 
METHODS: We randomized 120 patients to one of 12 groups targeting different hypnotic levels (BIS 70, 50, and 30) and various CeREMI (0, 2, 4, or 6 ng/mL). At pseudo-steady state, baseline values were observed, and a series of stimuli were applied. Changes in BIS, CVI, heart rate (HR), and mean arterial blood pressure (MAP) between baseline and response period were analyzed in relation to level of hypnosis, antinociception, and somatic response to the stimuli. 
RESULTS: CVI and BIS more accurately correlate with somatic response to an Observer Assessment of Alertness and Sedation-noxious stimulation than HR, MAP, CeREMI, and propofol effect-site concentration (Tukey post hoc tests P < 0.01). Change in CVI is more adequate to monitor response to stimulation than changes in BIS, HR, or MAP (as described by the Mathews Correlation Coefficient with significance level set at P < 0.001). In contrast, none of the candidate analgesic state indices was uniquely related to a specific opioid concentration and is extensively influenced by the hypnotic state as measured by BIS. 
CONCLUSIONS: CVI appears to correlate with somatic responses to noxious stimuli. However, unstimulated CVI depends more on hypnotic drug effect than on opioid concentration.},
  author       = {Sahinovic, Marco M and Eleveld, Douglas J and Kalmar, Alain F and Heeremans, Eleonora H and De Smet, Tom and Seshagiri, Chandran V and Absalom, Anthony R and VEREECKE, HUGO and Struys, Michel},
  issn         = {0003-2999},
  journal      = {ANESTHESIA AND ANALGESIA},
  keywords     = {Surgical Stress Index,Propofol-Remifentanil Anesthesia,Heart-Rate,General-Anesthesia,Noxious Stimuli,Performance,Depth,Pharmacokinetics,Skin Incision,Bispectral Index},
  language     = {eng},
  number       = {2},
  pages        = {288--301},
  title        = {Accuracy of the composite variability index as a measure of the balance between nociception and, antinociception during anesthesia},
  url          = {http://dx.doi.org/10.1213/ANE.0000000000000274},
  volume       = {119},
  year         = {2014},
}

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