Impact of chronic treatment by β1-adrenergic antagonists on Nociceptive-Level (NOL) index variation after a standardized noxious stimulus under general anesthesia: a cohort study

• Published in: Journal of clinical monitoring and computing 2022-02, Vol.36 (1), p.109-120
• Main Authors: Bergeron, Catherine, Brulotte, Véronique, Pelen, Felix, Clairoux, Ariane, Bélanger, Marie-Eve, Issa, Rami, Urbanowicz, Robert, Tanoubi, Issam, Drolet, Pierre, Fortier, Louis-Philippe, Verdonck, Olivier, Fortier, Annik, Espitalier, Fabien, Richebé, Philippe
• Format: Article
• Language: English
• Subjects: Anesthesia; Anesthesiology; Beta blockers; Cohort analysis; Critical Care Medicine; General anesthesia; Health Sciences; Heart rate; Intensive; Medicine; Medicine & Public Health; Narcotics; Original Research; Pain; Patients; Sensitivity; Statistics for Life Sciences; Stimulation; Stimuli; Variability
• ISSN: 1387-1307; 1573-2614
• DOI: 10.1007/s10877-020-00626-4

During the perioperative period, nociception control is certainly one of the anesthesiologist's main objectives when assuming care of a patient. There exists some literature demonstrating that the nociceptive stimuli experienced during surgery are responsible for peripheral and central sensitization phenomena, which can in turn lead to persistent postsurgical pain. An individualized approach to the evaluation and treatment of perioperative nociception is beneficial in order to avoid the sensitization phenomena that leads to prolonged postoperative pain and to minimize the consumption of opiates and their adverse effects. In terms of sensitivity, specificity, and positive/negative predictive values when compared to heart rate (HR) and mean arterial pressure (MAP), recent literature has shown that the NOL variation (ΔNOL) is the best index to distinguish noxious from non-noxious stimuli. Chronic treatment with β1-adrenergic antagonists may constitute a limitation to the use of the NOL index. β1-adrenergic antagonists induce a depressive action on the heart rate, which results in a limitation of its variability after a noxious stimulus. Since heart rate and heart rate variability are two parameters integrated into the NOL index, the validity of the NOL index in a population of patients receiving β1-adrenergic antagonists has not yet been determined. Our study sought to explore the NOL index, the BIS, and the heart rate variation in a group of patients under chronic treatment with β1-adrenergic antagonists submitted to standardized noxious stimulus under general anesthesia. We then compared those results to a control group of patients from our previous study (CJA group) that received no β1-adrenergic antagonist chronic treatment. The patients in this study were subjected to a standardized anesthetic protocol from induction up to 3 min after a standardized tetanic stimulus to the ulnar nerve at a frequency of 100 Hz and an amperage of 70 mA, for a duration of 30 s. Data were electronically recorded to obtain NOL, BIS, and heart rate values every 5 s for the duration of the protocol. The NOL maximal mean value reached after noxious stimulation was not different between our two cohorts (CJA: 30(14) versus BETANOL: 36(14) (p = 0.12)). There was no statistically significant difference between our cohorts in regards of the NOL AUC representing the variation of the NOL over a 180 s period (CJA: 595(356) versus BETANOL: 634(301) (p = 0.30)). However, a repeated measur