Cortical, subcortical, brainstem and autonomic responses to nociception under total intravenous anesthesia
Authors' conclusion
PRD, HR, and BIS correlated with varying levels of remifentanil, with PRD exhibiting the strongest correlation. When CE remifentanil are low, noxious stimuli are more likely to dilate the pupil and be detected in the EEG.
Study context
- Population
- Patients under GA with TCI of propofol and remifentanil
- Exposure
- NOL, Analgesia Nociception Index (ANI), Pupillary Reflex Dilation (PRD), raw and processed EEG (BIS, qCON, qNOX) and HR responses to standardized tetanic stimulation under varying propofol and remifentanil concentrations
- Outcome
- Performance of nociception monitors in response to standardized tetanic stimulation and correlation with varying remifentanil concentrations
Main finding
As reported in the abstract
- ANI, BIS, HR, NOL, PRD and qNOX significantly changed after noxious stimulation
- PRD had the strongest correlation with varying remifentanil concentrations
- ANI, NOL and qNOX showed no significant correlation with remifentanil concentrations
Observational data: associations, not effects.
Further findings
Raw EEG power spectral density after noxious stimulus in patients with low PRD
- Significant increase in power in high EEG frequencies around 25 Hz and decreased power in alpha range (8-12 Hz)
Original publication
Cortical, subcortical, brainstem and autonomic responses to nociception under total intravenous anesthesia. J Clin Anesth. Published 12 April 2025. doi:10.
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