The Journal of Practical Medicine >
Effects of surgical pleth index and nociception index on the consumption of remifentanil and postoperative recovery in children undergoing adenotonsillectomy
Received date: 2025-03-31
Online published: 2025-07-18
Objective To investigate the appropriate indicators for monitoring pediatric nociceptive stimulation， this study compared the SPI and NOX， two dual-parameter nociceptive stimulation monitors based on different principles， in terms of their effects on remifentanil consumption and postoperative recovery in pediatric adenotonsillectomy. Methods Children aged 3 ~ 12 years who were scheduled to undergo adenotonsillectomy under general anesthesia with endotracheal intubation were randomly assigned to the conventional group （Group R， n = 19）， the SPI group （Group S， n = 19）， and the NOX group （Group N， n = 18） according to the type of nociceptive stimulation monitor used. All children were subjected to routine fasting. The depth of anesthesia was monitored using a BIS monitor， and the remifentanil infusion rate was adjusted according to heart rate， SPI， or NOX values to maintain the index within the range of 30 ~ 50. After surgery， all children were transferred to the Post-Anesthesia Care Unit （PACU） with the tracheal catheter in place until they recovered. During the operation， the consumption of anesthetics such as remifentanil was recorded. Postoperatively， pain and agitation scores， the incidence of agitation at different time points， the duration of anesthesia， the surgical time， the time to extubation， and the length of stay in the recovery room were measured. Additionally， postoperative adverse reactions and perioperative vital signs were documented. Results In comparison with Group R， in Group N， the intraoperative consumption of remifentanil and the agitation score during the recovery period were significantly reduced. Conversely， in Group S， both of these two indicators were significantly elevated （P < 0.05）. Among the three groups， the residence time in the Post-Anesthesia Care Unit （PACU） was the shortest in Group N， and this difference was statistically significant （P < 0.05）. There were no significant disparities in the FLACC score， the incidence of agitation， and the extubation time among the three groups. Conclusions The NOX index can serve as a quantitative metric for monitoring nonciceptive stimulation during pediatric adenotonsillectomy. This index has the potential to decrease the intraoperative consumption of opioids and the residence time in the recovery room.
Yuping YE , Junling LI , Guodong LIU , Yong WEI , Dan XIAO , Saijun HUANG , Shiyuan XU . Effects of surgical pleth index and nociception index on the consumption of remifentanil and postoperative recovery in children undergoing adenotonsillectomy[J]. The Journal of Practical Medicine, 2025 , 41(13) : 2018 -2024 . DOI: 10.3969/j.issn.1006-5725.2025.13.011
| [1] | RECKLEY L K， FERNANDEZ-SALVADOR C， CAMACHO M. The effect of tonsillectomy on obstructive sleep apnea： An overview of systematic reviews［J］. Nat Sci Sleep， 2018， 10： 105-110. doi:10.2147/nss.s127816 |
| [2] | BONE M E， FELL D. A comparison of rectal diclofenac with intramuscular papaveretum or placebo for pain relief following tonsillectomy［J］. Anaesthesia， 1988， 43（4）： 277-280. doi:10.1111/j.1365-2044.1988.tb08972.x |
| [3] | JANSSEN K J M， KALKMAN C J， GROBBEE D E， et al. The Risk of Severe Postoperative Pain： Modification and Validation of a Clinical Prediction Rule［J］.Anesth Analg， 2008， 107（4）： 1330-1339. doi:10.1213/ane.0b013e31818227da |
| [4] | GRUENEWALD M， DEMPFLE A. Analgesia/nociception monitoring for opioid guidance： Meta-analysis of randomized clinical trials［J］. Minerva Anestesiol， 2017， 83（2）：200-213. doi:10.23736/s0375-9393.16.11602-5 |
| [5] | ISAIAH A， KISS E， OLOMU P， et al. Characterization of upper airway obstruction using cine MRI in children with residual obstructive sleep apnea after adenotonsillectomy［J］. Sleep Med， 2018， 50： 79-86. doi:10.1016/j.sleep.2017.10.006 |
| [6] | SANTA CRUZ MERCADO L A， LIU R， BHARADWAJ K M， et al. Association of Intraoperative Opioid Administration With Postoperative Pain and Opioid Use［J］. JAMA Surg， 2023， 158（8）： 854. doi:10.1001/jamasurg.2023.2009 |
| [7] | IANNUZZI M， IANNUZZI E， ROSSI F， et al. Relationship between Bispectral Index， electroencephalographic state entropy and effect-site EC 50 for propofol at different clinical endpoints［J］. Br J Anaesth， 2005， 94（4）： 492-495. doi:10.1093/bja/aei075 |
| [8] | SHALBAF R， BEHNAM H， SLEIGH J W， et al. Monitoring the depth of anesthesia using entropy features and an artificial neural network［J］.J Neurosci Methods， 2013， 218（1）： 17-24. doi:10.1016/j.jneumeth.2013.03.008 |
| [9] | STANKO D， BERGESIO R， DAVIES K， et al. Postoperative pain， nausea and vomiting following adeno-tonsillectomy-a long-term follow-up［J］. Paediatr Anaesth， 2013， 23（8）： 690-696. doi:10.1111/pan.12170 |
| [10] | 曹晓晟，黄亚龙，欧连春，等. 超声引导喉上神经阻滞在小儿扁桃体腺样体等离子切除术中的应用效果［J］. 中国医学创新，2024，21（36）：10-14. |
| [11] | LEDOWSKI T. Objective monitoring of nociception： A review of current commercial solutions［J］. Br J Anaesth， 2019， 123（2）： e312-e321. doi:10.1016/j.bja.2019.03.024 |
| [12] | MEIJER F， HONING M， ROOR T， et al. Reduced postoperative pain using Nociception Level-guided fentanyl dosing during sevoflurane anaesthesia： a randomised controlled trial［J］.Br J Anaesth， 2020， 125（6）： 1070-1078. doi:10.1016/j.bja.2020.07.057 |
| [13] | AVEZ-COUTURIER J， DE JONCKHEERE J， JEANNE M， et al. Assessment of Procedural Pain in Children Using Analgesia Nociception Index： A Pilot Study［J］. Clin J Pain， 2016， 32（12）： 1100-1104. doi:10.1097/ajp.0000000000000360 |
| [14] | GHANTY I， SCHRAAG S. The quantification and monitoring of intraoperative nociception levels in thoracic surgery： A review［J］.J Thorac Dis， 2019， 11（9）： 4059-4071. doi:10.21037/jtd.2019.08.62 |
| [15] | OH S K， WON Y J， LIM B G. Surgical pleth index monitoring in perioperative pain management： Usefulness and limitations［J］.Korean J Anesthesiol， 2024， 77（1）： 31-45. doi:10.4097/kja.23158 |
| [16] | JENSEN E W， VALENCIA J F， LóPEZ A， et al. Monitoring hypnotic effect and nociception with two EEG-derived indices， qCON and qNOX， during general anaesthesia： Monitoring anaesthesia with qCON and qNOX［J］. Acta Anaesthesiol Scand， 2014， 58（8）： 933-941. doi:10.1111/aas.12359 |
| [17] | 邓伟，彭丹，胡海军，等. 伤害指数联合脑电双频指数监测下全身麻醉在腹腔镜结直肠癌根治术中的应用［J］. 实用医学杂志，2024，40（24）：3476-3481. |
| [18] | CONNOR C W. Open Reimplementation of the BIS Algorithms for Depth of Anesthesia［J］. Anesth Analg， 2022， 135（4）： 855-864. doi:10.1213/ane.0000000000006119 |
| [19] | LOCATELLI B G， INGELMO P M， EMRE S， et al. Emergence delirium in children： A comparison of sevoflurane and desflurane anesthesia using the Paediatric Anesthesia Emergence Delirium scale［J］. Paediatr Anaesth， 2013， 23（4）： 301-308. doi:10.1111/pan.12038 |
| [20] | SAYNHALATH R， DISMA N， TAVERNER F J， et al. Short-term Outcomes in Infants after General Anesthesia with Low-dose Sevoflurane/Dexmedetomidine/Remifentanil versus Standard-dose Sevoflurane （the TREX Trial）［J］. Anesthesiology， 2024， 141（6）： 1075-1085. doi:10.1097/aln.0000000000005232 |
| [21] | CHEN F， WANG C Y， ZHANG J， et al. Comparison of Postoperative Analgesic Effects Between Nalbuphine and Fentanyl in Children Undergoing Adenotonsillectomy： A Prospective， Randomized， Double-Blind， Multicenter Study［J］.Front Pharmacol， 2020， 11： 597550. doi:10.3389/fphar.2020.597550 |
| [22] | HE J， ZHANG L， TAO T， et al. Nalbuphine reduces the incidence of emergence agitation in children undergoing Adenotonsillectomy： A prospective， randomized， double-blind， multicenter study［J］. J Clin Anesth， 2023， 85： 111044. doi:10.1016/j.jclinane.2022.111044 |
| [23] | MOORE A D， ANGHELESCU D L. Emergence Delirium in Pediatric Anesthesia［J］. Pediatric Drugs， 2017， 19（1）： 11-20. doi:10.1007/s40272-016-0201-5 |
| [24] | YU H， SUN X， LI P， et al. Prevalence and risk factors of emergence agitation among pediatric patients undergo ophthalmic and ENT Surgery： A cross-sectional study［J］. BMC Pediatr， 2023， 23（1）： 598. doi:10.1186/s12887-023-04434-y |
| [25] | BAEK J， PARK S J， KIM J O， et al. The Effects of Remifentanil and Fentanyl on Emergence Agitation in Pediatric Strabismus Surgery［J］. Children， 2022， 9（5）： 606. doi:10.3390/children9050606 |
| [26] | HAN Y， MIAO M， LI P， et al. EEG-Parameter-Guided Anesthesia for Prevention of Emergence Delirium in Children［J］.Brain Sci， 2022， 12（9）： 1195. doi:10.3390/brainsci12091195 |
| [27] | LEDOWSKI T， SOMMERFIELD D， SLEVIN L， et al. Surgical pleth index： Prediction of postoperative pain in children？［J］.Br J Anaesth， 2017， 119（5）： 979-983. doi:10.1093/bja/aex300 |
/
| 〈 |
|
〉 |