Despite various efforts there is still the need for adequate monitoring of pain and nociception during anesthesia. In a previous protocol the investigators measured pain responses during anesthesia based on single end-points, eg heart rate,blood pressure and pulse transit time. None of these parameters provided sufficient information regarding nociception. The investigators therefore want to further investigate this matter using a composite parameter, the Nociception Level or NoL. The NoL is a novel index that measures the magnitude of the autonomic response to painful stimuli. The NoL combines information from several physiological parameters, which represent different autonomic pathways. The multi-parameter approach empowered with state-of-the-art signal processing and machine learning techniques. In the current study the investigators will measure the NoL in ASA 1-3 patients undergoing elective surgery under general anesthesia. The investigators will measure NoL responses and the occurrence of patient movement upon the administration of a painful stimulus: Introduction of the laryngoscope, Insertion of the endotracheal tube, Insertion of the gastric tube, Insertion of the bladder catheter and Skin incision.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
TRIPLE
Enrollment
96
Propofol will be titrated via a target controlled infusion to reach a specific target BIS (as specified in treatment arm)
Remifentanil will be provided by a target controlled infusion to a specific effect site concentration (as specified in treatment arm)
Leiden University Medical Center
Leiden, Netherlands
Nociception level index (NoI)
The NoL measures the magnitude of the autonomic responses to painful stimuli. The NoL combines information from several physiological parameters which represent different autonomic pathways.
Time frame: Between induction and first incision
Cardiovascular parameters
Individual pain related cardiovascular parameters, as heart rate, blood pressure and PPG wave amplitude.
Time frame: Between induction and first incision
Movement
Visible occurence of movement during painfull stimuli.
Time frame: Between induction and first incision
Depth of anesthesia
Depth of anesthesia is measured by a Bispectral Index monitor. Changes in depth of anesthesia will be recorded during painfull stimuli
Time frame: Between induction and first incision
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