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Master Thesis

Capacité des variations de l’Analgesia Nociception Index à identifier une réponse à un remplissage vasculaire de 250 ml de cristalloïdes au bloc opératoire . Étude REVANI

Abstract : Background: analgesia Nociception Index (ANI) is a device based on R-R interval analysis for nociception balance evaluation using heart rate variability. The autonomic nervous system is directly affected by load changes as hypovolemia. The aim of the present study was to determine whether changes in ANI are able to track volume expansion induced increases in stroke volume (SV). Methods: this prospective and observational study included mechanically ventilated patients undergoing neurosurgery and benefiting from SV monitoring. Exclusion criteria were cardiac dysfunction, arrhythmia, betablockade therapy and dysautonomia. SV was optimized using 250 ml fluid challenge of crystalloids. Positive fluid challenges were defined as a SV increase of 10% or more from baseline. Changes in SV and medium ANI (ANIm) were recorded before and 4 to 5 minutes after volume expansion. Results: overall, 104 volume expansion (36 positives and 68 negatives) fluid challenges were performed in sixty-nine patients. Change in ANIm > 5 predicted fluid responsiveness with a sensitivity of 68.4% (95% CI: 67.4 to 69.5%) and a specificity of 51.2% (95% CI: 50.1 to 52.3%). The area under the receiver operating characteristic curve was 0.546 (95% CI: 0.544 to 0.549) and seemed influenced by remifentanil dosage and baseline ANI value. Conclusions: changes in ANIm induced by fluid challenge seem not able to predict fluid responsiveness in mechanically ventilated patients undergoing neurosurgery in operating room. Further studies including patients receiving no or limited opioid might be relevant.
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https://dumas.ccsd.cnrs.fr/dumas-03382353
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Submitted on : Monday, October 18, 2021 - 10:52:07 AM
Last modification on : Thursday, November 25, 2021 - 3:15:46 AM
Long-term archiving on: : Wednesday, January 19, 2022 - 8:16:15 PM

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Benjamin Abel. Capacité des variations de l’Analgesia Nociception Index à identifier une réponse à un remplissage vasculaire de 250 ml de cristalloïdes au bloc opératoire . Étude REVANI. Sciences du Vivant [q-bio]. 2021. ⟨dumas-03382353⟩

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