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Neumann, Claudia; Babasiz, Tamara; Straßberger‐Nerschbach, Nadine; Schindler, Ehrenfried; Reuter, Christian; Weinhold, Leonie; Wittmann, Maria; Hilbert, Tobias; Klaschik, Sven

Comparison of the Newborn Infant Parasympathetic Evaluation (NIPE™) index to changes in heart rate to detect intraoperative nociceptive stimuli in healthy and critically ill children below 2 years: An observational study

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  • Medientyp: E-Artikel
  • Titel: Comparison of the Newborn Infant Parasympathetic Evaluation (NIPE™) index to changes in heart rate to detect intraoperative nociceptive stimuli in healthy and critically ill children below 2 years: An observational study
  • Beteiligte: Neumann, Claudia; Babasiz, Tamara; Straßberger‐Nerschbach, Nadine; Schindler, Ehrenfried; Reuter, Christian; Weinhold, Leonie; Wittmann, Maria; Hilbert, Tobias; Klaschik, Sven
  • Erschienen: Wiley, 2022
  • Erschienen in: Pediatric Anesthesia
  • Sprache: Englisch
  • DOI: 10.1111/pan.14446
  • ISSN: 1155-5645; 1460-9592
  • Entstehung:
  • Anmerkungen:
  • Beschreibung: <jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>The validity of current tools for intraoperative objective assessment of nociception/antinociception balance during anesthesia in young and very young surgery children is unknown.</jats:p></jats:sec><jats:sec><jats:title>Aim</jats:title><jats:p>Primary aim of the study was to test the hypothesis that the Newborn Infant Parasympathetic Evaluation (NIPE) index performs better in indicating nociception in anesthetized children below 2 years than changes in heart rate. Secondary aims were to evaluate associations between intraoperative changes in NIPE index values and postoperative pain and emergence delirium.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Fifty‐one children aged &lt;2 years who underwent surgery were included in this prospective observational study. Patients were assigned to either group 1 (healthy children, <jats:italic>n</jats:italic> = 31) or group 2 (critically ill, ventilated premature infants and neonates, <jats:italic>n</jats:italic> = 20). The NIPE index and heart rate in response to three defined nociceptive stimuli were continuously recorded. Two different scales, <jats:italic>Kindliche Unbehagens‐ und Schmerzskala</jats:italic> (KUS) and <jats:italic>Pediatric Anesthesia Emergence Delirium</jats:italic> (PAED) as well as a Pain Questionnaire were used to assess postoperative pain levels and emergence delirium.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>In total, 110 nociceptive events were evaluated. The analysis revealed a statistically significant association between a decrease in the NIPE index and all nociceptive stimuli, with a sensitivity of 92% and a specificity of 96%. The mean percentage decrease ranged from approx. 15%–30% and was highly statistically significant in both groups and for each of the nociceptive events except for venous puncture (<jats:italic>p</jats:italic> = .004). In contrast, no consistent change in heart rate was demonstrated. The KUS and PAED scale scores were significantly associated with the duration of anesthesia (<jats:italic>p</jats:italic> = .04), but not with intraoperative NIPE depression.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>The NIPE index was reliable for assessing intraoperative nociception in children aged &lt;2 years and was more reproducible for detecting specific nociceptive stimuli during general anesthesia than heart rate. An effect on postoperative outcome is still elusive.</jats:p></jats:sec>