ABSTRACT
BACKGROUND: The analgesia/nociception index (ANI) is derived from heart rate variability, ranging from 0 (maximal nociception) to 100 (maximal analgesia), to reflect the analgesia/nociception balance during general anaesthesia. This should be correlated with immediate postoperative pain in the post-anaesthesia care unit (PACU). The aim of this study was to evaluate the performance of ANI measured at arousal from general anaesthesia to predict immediate postoperative pain on arrival in PACU. METHODS: Two hundred patients undergoing ear, nose, and throat or lower limb orthopaedic surgery with general anaesthesia using an inhalational agent and remifentanil were included in this prospective observational study. The ANI was measured immediately before tracheal extubation and pain intensity was assessed within 10 min of arrival in PACU using a 0-10 numerical rating scale (NRS). The relationship between ANI and NRS was assessed using linear regression. A receiver-operating characteristic (ROC) curve was used to evaluate the performance of ANI to predict NRS>3. RESULTS: A negative linear relationship was observed between ANI immediately before extubation and NRS on arrival in PACU. Using a threshold of <50, the sensitivity and specificity of ANI to discriminate between patients with NRS≤3 and NRS>3 were both 86% with 92% negative predictive value, corresponding to an area under the ROC curve of 0.89. CONCLUSIONS: The measurement of ANI immediately before extubation after inhalation-remifentanil anaesthesia was significantly associated with pain intensity on arrival in PACU. The performance of ANI for the prediction of immediate postoperative pain is good and may assist physicians in optimizing acute pain management. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT01796249.
Subject(s)
Analgesia/methods , Nociception/physiology , Pain, Postoperative/diagnosis , Adult , Aged , Anesthesia Recovery Period , Anesthesia, General/methods , Female , Heart Rate/physiology , Humans , Male , Middle Aged , Pain Measurement/methods , Postoperative Care/methods , Predictive Value of Tests , Prospective Studies , Sensitivity and SpecificityABSTRACT
BACKGROUND: The analgesia/nociception index (ANI), a 0-100 non-invasive index calculated from heart rate variability, reflects the analgesia/nociception balance during general anaesthesia. The aim of this study was to evaluate the ANI in the assessment of immediate postoperative pain in adult patients undergoing general anaesthesia. METHODS: Two-hundred patients undergoing scheduled surgery or endoscopy with general anaesthesia were included in this prospective observational study. Pain intensity was assessed using a 0-10 numerical rating scale (NRS) after arousal from general anaesthesia. Receiver-operating characteristic (ROC) curves were built to assess the performance of ANI to detect patients with NRS>3 and NRS ≥ 7 on arrival in the postoperative care unit. RESULTS: A negative linear relationship was observed between ANI and NRS (ANI=-5.2 × NRS+77.9, r(2)=0.41, P<0.05). At the threshold of 57, the sensitivity and specificity of ANI to detect patients with NRS>3 were 78 and 80%, respectively, with a negative predictive value of 88%, corresponding to an area under the ROC curve (AUC) of 0.86. At the threshold of 48, the sensitivity and specificity of ANI to detect NRS ≥ 7 were 92 and 82%, respectively, with a negative predictive value of 99%, corresponding to a ROC curve AUC of 0.91. CONCLUSIONS: A measurement of ANI during the immediate postoperative period is significantly correlated with pain intensity. The measurement of ANI appears to be a simple and non-invasive method to assess immediate postoperative analgesia.
Subject(s)
Analgesia , Anesthesia, General , Nociception/drug effects , Pain Measurement/methods , Pain, Postoperative/diagnosis , Adult , Area Under Curve , Female , Heart Rate/drug effects , Humans , Male , Prospective Studies , ROC Curve , Sensitivity and SpecificityABSTRACT
Broncholithiasis is usually a late complication of tuberculous lymphadenopathy. Clinical symptoms are not suggestive of the condition in most cases, except for lithoptysis which occurs in 5 to 34% of the patients. Owing to the currently low frequency of tuberculosis, broncholithiasis is a rare and sometimes surprising diagnosis, as in the case reported here. In this 65-year old silicotic man, broncholithiasis was manifested by blood-stained expectoration. Fibroscopy established the diagnosis by showing 2 broncholiths, about 1 cm wide, which were endoscopically extracted. The second peculiarity of this case is that broncholithiasis was associated with active tuberculosis.
