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Noxious stimulation response index: a novel anesthetic state index based on hypnotic-opioid interaction

Martin Luginbuhl, Peter M Schumacher, Pascal Vuilleumier, HUGO VEREECKE UGent, Björn Heyse UGent, Thomas W Bouillon and Michel Struys UGent (2010) ANESTHESIOLOGY. 112(4). p.872-880
abstract
Background: The noxious stimulation response index (NSRI) is a novel anesthetic depth index ranging between 100 and 0, computed from hypnotic and opioid effect-site concentrations using a hierarchical interaction model. The authors validated the NSRI on previously published data. Methods: The data encompassed 44 women, American Society of Anesthesiology class I, randomly allocated to three groups receiving remifentanil infusions targeting 0, 2, and 4 ng/ml. Propofol was given at stepwise increasing effect-site target concentrations. At each concentration, the observer assessment of alertness and sedation score, the response to eyelash and tetanic stimulation of the forearm, the bispectral index (BIS), and the acoustic evoked potential index (AAI) were recorded. The authors computed the NSRI for each stimulation and calculated the prediction probabilities (P(kappa)s) using a bootstrap technique. The P(kappa)s of the different predictors were compared with multiple pairwise comparisons with Bonferroni correction. Results: The median (95% CI) PK of the NSRI, BIS, and AAI for loss of response to tetanic stimulation was 0.87 (0.75-0.96), 0.73 (0.58-0.85), and 0.70 (0.54-0.84), respectively. The PK of effect-site propofol concentration, BIS, and AAI for observer assessment of alertness and sedation score and loss of eyelash reflex were between 0.86 (0.80-0.92) and 0.92 (0.83-0.99), whereas the P(kappa)s of NSRI were 0.77 (0.68-0.85) and 0.82 (0.68-0.92). The PK of the NSRI for BIS and AAI was 0.66 (0.58-0.73) and 0.63 (0.55-0.70), respectively. Conclusion: The NSRI conveys information that better predicts the analgesic component of anesthesia than AAI, BIS, or predicted propofol or remifentanil concentrations. Prospective validation studies in the clinical setting are needed.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
PHARMACODYNAMIC INTERACTION, BISPECTRAL INDEX, GENERAL-ANESTHESIA, SKIN-CONDUCTANCE, PROPOFOL, REMIFENTANIL, PHARMACOKINETICS, RESPONSIVENESS, INTUBATION, ENTROPY
journal title
ANESTHESIOLOGY
Anesthesiology
volume
112
issue
4
pages
872 - 880
Web of Science type
Article
Web of Science id
000276134500013
JCR category
ANESTHESIOLOGY
JCR impact factor
5.486 (2010)
JCR rank
1/26 (2010)
JCR quartile
1 (2010)
ISSN
0003-3022
DOI
10.1097/ALN.0b013e3181d40368
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
931288
handle
http://hdl.handle.net/1854/LU-931288
date created
2010-04-19 14:48:26
date last changed
2010-04-27 16:16:06
@article{931288,
  abstract     = {Background: The noxious stimulation response index (NSRI) is a novel anesthetic depth index ranging between 100 and 0, computed from hypnotic and opioid effect-site concentrations using a hierarchical interaction model. The authors validated the NSRI on previously published data.
Methods: The data encompassed 44 women, American Society of Anesthesiology class I, randomly allocated to three groups receiving remifentanil infusions targeting 0, 2, and 4 ng/ml. Propofol was given at stepwise increasing effect-site target concentrations. At each concentration, the observer assessment of alertness and sedation score, the response to eyelash and tetanic stimulation of the forearm, the bispectral index (BIS), and the acoustic evoked potential index (AAI) were recorded. The authors computed the NSRI for each stimulation and calculated the prediction probabilities (P(kappa)s) using a bootstrap technique. The P(kappa)s of the different predictors were compared with multiple pairwise comparisons with Bonferroni correction.
Results: The median (95\% CI) PK of the NSRI, BIS, and AAI for loss of response to tetanic stimulation was 0.87 (0.75-0.96), 0.73 (0.58-0.85), and 0.70 (0.54-0.84), respectively. The PK of effect-site propofol concentration, BIS, and AAI for observer assessment of alertness and sedation score and loss of eyelash reflex were between 0.86 (0.80-0.92) and 0.92 (0.83-0.99), whereas the P(kappa)s of NSRI were 0.77 (0.68-0.85) and 0.82 (0.68-0.92). The PK of the NSRI for BIS and AAI was 0.66 (0.58-0.73) and 0.63 (0.55-0.70), respectively.
Conclusion: The NSRI conveys information that better predicts the analgesic component of anesthesia than AAI, BIS, or predicted propofol or remifentanil concentrations. Prospective validation studies in the clinical setting are needed.},
  author       = {Luginbuhl, Martin and Schumacher, Peter M and Vuilleumier, Pascal and VEREECKE, HUGO and Heyse, Bj{\"o}rn and Bouillon, Thomas W and Struys, Michel},
  issn         = {0003-3022},
  journal      = {ANESTHESIOLOGY},
  keyword      = {PHARMACODYNAMIC INTERACTION,BISPECTRAL INDEX,GENERAL-ANESTHESIA,SKIN-CONDUCTANCE,PROPOFOL,REMIFENTANIL,PHARMACOKINETICS,RESPONSIVENESS,INTUBATION,ENTROPY},
  language     = {eng},
  number       = {4},
  pages        = {872--880},
  title        = {Noxious stimulation response index: a novel anesthetic state index based on hypnotic-opioid interaction},
  url          = {http://dx.doi.org/10.1097/ALN.0b013e3181d40368},
  volume       = {112},
  year         = {2010},
}

Chicago
Luginbuhl, Martin, Peter M Schumacher, Pascal Vuilleumier, HUGO VEREECKE, Björn Heyse, Thomas W Bouillon, and Michel Struys. 2010. “Noxious Stimulation Response Index: a Novel Anesthetic State Index Based on Hypnotic-opioid Interaction.” Anesthesiology 112 (4): 872–880.
APA
Luginbuhl, M., Schumacher, P. M., Vuilleumier, P., VEREECKE, H., Heyse, B., Bouillon, T. W., & Struys, M. (2010). Noxious stimulation response index: a novel anesthetic state index based on hypnotic-opioid interaction. ANESTHESIOLOGY, 112(4), 872–880.
Vancouver
1.
Luginbuhl M, Schumacher PM, Vuilleumier P, VEREECKE H, Heyse B, Bouillon TW, et al. Noxious stimulation response index: a novel anesthetic state index based on hypnotic-opioid interaction. ANESTHESIOLOGY. 2010;112(4):872–80.
MLA
Luginbuhl, Martin, Peter M Schumacher, Pascal Vuilleumier, et al. “Noxious Stimulation Response Index: a Novel Anesthetic State Index Based on Hypnotic-opioid Interaction.” ANESTHESIOLOGY 112.4 (2010): 872–880. Print.