ANI Parasympathetic Monitoring in Neurosurgery

NCT ID: NCT03978819

Last Updated: 2019-06-07

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

100 participants

Study Classification

OBSERVATIONAL

Study Start Date

2015-11-30

Study Completion Date

2017-11-30

Brief Summary

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Surgery of large cerebellopontine angle (CPA) tumors (\>2 x 2 cm diameter), with compression of the pons exposes the patient to inadvertent parasympathetic nerve stimulation (IPNS) leading to bradycardia and asystole.

The analgesia nociception index (ANI) monitor assesses the balance between analgesia and nociception through the detection of parasympathetic tone. ANI \>80 generally denotes excessive analgesia (EA). The main objective of this study was to determine whether ANI values for IPNS are different or the same as ANI values for EA. This study also aims at calculating the number of patients with IPNS and EA during surgery of large CPA tumours.

Detailed Description

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Bradycardia and asystole are potential life threatning complications during surgery of large cerebellopontine angle (CPA) tumors (\>2 x 2 cm diameter), with compression of the pons.The incidence of such complications are unknown. One of the plausible mechanisms is inadvertent parasympathetic nerve stimulation (IPNS) due to the proximity of this cranial nerve to the CPA tumor. Monitoring parasympathetic nerve activity may provide further insight to the implication of this cranial nerve in the cardiac complications observed during surgery of large CPA tumors. The analgesia nociception index (ANI) monitor assesses the balance between analgesia and nociception through the detection of parasympathetic tone. Despite the abundant clinical reports about this index, to the knowledge of the investigators, only a few studies have been published in the neurological setting. Moreover, there are no data reporting the parasympathetic profile (measured by the ANI monitor) in situations of IPNS and EA. Are these profiles the same or different? Such is the main question this study thrives to answer. Understanding the behavior of parasympathetic nerve activity in this context could help provide the appropriate management strategy.

In order to answer this question, participants undergoing elective large CPA tumor surgery were included in this prospective observational study. Standard cardiorespiratory monitoring including heart rate (HR) was done. Target-controlled anesthesia with Propofol and Remifentanil was guided by a bispectral index of 30-40 and an ANI of 50-70 respectively. Data was continuously recorded with event markers at the onset of bradycardia (HR \< 45 bpm), asystole and the coincidence of ANI \> 80 with Remifentanil site effect \> 6 ng.ml-1 (defined as excessive analgesia).

Conditions

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Bradycardia

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Patients with large CPA tumors

Patients with large cerebellopontine angle tumors (\>2 x 2cm) undergoing elective surgery

ANI

Intervention Type DEVICE

ANI profiles during IPNS (bradycardia/asystole) or excessive analgesia.

During surgery continuous monitoring of ANI, HR and Remifentanil effect site concentration was done and recorded. Event markers were placed at the onset of bradycardia, asystole and the coincidence of ANI\>80 + Remifentanil \>6ng/mL). ANI values of 1 min before and 1 min after the event were used for analysis.

Interventions

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ANI

ANI profiles during IPNS (bradycardia/asystole) or excessive analgesia.

During surgery continuous monitoring of ANI, HR and Remifentanil effect site concentration was done and recorded. Event markers were placed at the onset of bradycardia, asystole and the coincidence of ANI\>80 + Remifentanil \>6ng/mL). ANI values of 1 min before and 1 min after the event were used for analysis.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* patients undergoing elective surgery of large cerebellopontine angle tumors

Exclusion Criteria

* age below 18yr
* arrhythmia
* preoperative use of vagolytics, β-blockers and clonidine.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Bordeaux

OTHER

Sponsor Role collaborator

Association de Developpement de la Neuroanesthesie Reanimation

OTHER

Sponsor Role lead

Responsible Party

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Musa Sesay

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Musa Sesay, M.D

Role: PRINCIPAL_INVESTIGATOR

ADNR, Neuroanesthesia and Critical Care, 33076 Bordeaux, France

Matthieu Biais, M.D., PhD

Role: STUDY_DIRECTOR

Neuroanesthesia and Critical Care, CHU University Bordeaux

Karine Nouette-Gaulain, M.D., Ph.D

Role: STUDY_CHAIR

Neuroanesthesia and Critical Care, CHU University Bordeaux

Locations

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CHU Bordeaux University Hospital

Bordeaux, , France

Site Status

Countries

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France

References

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Renowden S. Imaging of the cerebello-pontine angle. Pract Neurol. 2014 Oct;14(5):e2. doi: 10.1136/practneurol-2014-000949. Epub 2014 Aug 12. No abstract available.

Reference Type BACKGROUND
PMID: 25118279 (View on PubMed)

Sesay M, Vignes JR, Stockle M, Mehsen M, Boulard G, Maurette P. [Spectral analysis of the ECG R-R interval permits early detection of vagal responses to neurosurgical stimuli]. Ann Fr Anesth Reanim. 2003 May;22(5):421-4. doi: 10.1016/s0750-7658(03)00094-7. French.

Reference Type BACKGROUND
PMID: 12831969 (View on PubMed)

De Jonckheere J, Rommel D, Nandrino JL, Jeanne M, Logier R. Heart rate variability analysis as an index of emotion regulation processes: interest of the Analgesia Nociception Index (ANI). Annu Int Conf IEEE Eng Med Biol Soc. 2012;2012:3432-5. doi: 10.1109/EMBC.2012.6346703.

Reference Type BACKGROUND
PMID: 23366664 (View on PubMed)

Jeanne M, Clement C, De Jonckheere J, Logier R, Tavernier B. Variations of the analgesia nociception index during general anaesthesia for laparoscopic abdominal surgery. J Clin Monit Comput. 2012 Aug;26(4):289-94. doi: 10.1007/s10877-012-9354-0. Epub 2012 Mar 28.

Reference Type BACKGROUND
PMID: 22454275 (View on PubMed)

Robin F, Sesay M, Kolanek B, Pena D, Penna M, Morel-Locket L et al. The analgesia nociception index monitor (ANI) can detect indvertent vagal stimulation during surgery of cerebello-pontine angle tumors. Br J Anaesth 2013;111: https: // doi.org/10.1093/bja/el_10195

Reference Type BACKGROUND

Kommula LK, Bansal S, Umamaheswara Rao GS. Analgesia Nociception Index Monitoring During Supratentorial Craniotomy. J Neurosurg Anesthesiol. 2019 Jan;31(1):57-61. doi: 10.1097/ANA.0000000000000464.

Reference Type BACKGROUND
PMID: 28991059 (View on PubMed)

Theerth KA, Sriganesh K, Reddy KM, Chakrabarti D, Umamaheswara Rao GS. Analgesia Nociception Index-guided intraoperative fentanyl consumption and postoperative analgesia in patients receiving scalp block versus incision-site infiltration for craniotomy. Minerva Anestesiol. 2018 Dec;84(12):1361-1368. doi: 10.23736/S0375-9393.18.12837-9. Epub 2018 Jul 9.

Reference Type BACKGROUND
PMID: 29991223 (View on PubMed)

Fletcher D, Martinez V. Opioid-induced hyperalgesia in patients after surgery: a systematic review and a meta-analysis. Br J Anaesth. 2014 Jun;112(6):991-1004. doi: 10.1093/bja/aeu137.

Reference Type BACKGROUND
PMID: 24829420 (View on PubMed)

Galley HF. Editorial II: Solid as a ROC. Br J Anaesth. 2004 Nov;93(5):623-6. doi: 10.1093/bja/aeh247. No abstract available.

Reference Type BACKGROUND
PMID: 15472141 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

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DC 2015/143

Identifier Type: -

Identifier Source: org_study_id

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