Abstract
Objective
To evaluate the performance of the Parasympathetic Tone Activity (PTA) index in assessing
the nociception–antinociception balance in anaesthetized dogs undergoing castration.
Study design
Prospective clinical study.
Animals
A group of 22 healthy client-owned dogs.
Methods
The dogs underwent general anaesthesia, with continuous monitoring of mean and instantaneous
PTA (PTAm, PTAi), mean arterial pressure and heart rate. The values of these variables
were divided according to the occurrence or absence of a haemodynamic reaction (HDR)
at different time points: during surgical preparation, cutaneous incision, testicles
extraction, cutaneous suture, after fentanyl administration, and after dexmedetomidine
administration during recovery. Data were collected initially and 1, 3 and 5 minutes
after each time point. The performance of the dynamic variation of the PTA (ΔPTA)
to predict HDR or its resolution within 3 or 5 minutes was assessed using receiver
operating characteristic (ROC) curves analysis. A p value < 0.05 was considered significant.
Results
During HDR, a decrease in PTAi (–34% and –31%) and PTAm (–26% and –30%) occurred at
3 (p = 0.005; p = 0.004) and 5 minutes (p = 0.001), respectively. After fentanyl administration, a decrease in haemodynamic
variables occurred with a 45% increase in PTAi (p = 0.004). The ROC curve analysis of pooled data of the ΔPTAi for the prediction of
HDR within 3 minutes indicated an area under the curve (AUC) of 0.70 (p = 0.0016) (threshold value: –16%). After fentanyl administration, the ROC curve analysis
of ΔPTAi for the prediction of resolution of HDR within 3 minutes indicated an AUC
of 0.69 (threshold value: +12%).
Conclusions and clinical relevance
The PTAi appears to be an interesting tool to assess the nociception–antinociception
balance. However, further studies with a variety of clinical scenarios and anaesthesia
protocols are required to conclude on its performance.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Veterinary Anaesthesia and AnalgesiaAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Efficacy of the Parasympathetic Tone Activity monitor to assess nociception in healthy dogs anaesthetized with propofol and sevoflurane.Vet Anaesth Analg. 2020; 47: 103-110
- Analgesia/nociception index for the assessment of acute postoperative pain.Brit J Anaesth. 2014; 112: 936-937
- Prediction of hemodynamic reactivity during total intravenous anesthesia for suspension laryngoscopy using Analgesia/Nociception Index (ANI): A prospective observational study.Minerva Anestesiol. 2015; 81: 288-297
- Prediction of hemodynamic reactivity using dynamic variations of Analgesia/Nociception Index (ΔANI).J Clin Monit Comput. 2016; 30: 977-984
- Analgesia nociception index for the assessment of pain in critically ill patients: a diagnostic accuracy study.Brit J Anaesth. 2017; 119: 812-820
- Differences between breeds of dog in a measure of heart rate variability.Vet Rec. 2004; 154: 713-717
- Periodic cardiovascular and ventilatory activity during midazolam sedation.Brit J Anaesth. 1996; 76: 503-507
- Evaluation of the effects of dexmedetomidine and remifentanil on pain with the analgesia nociception index in the perioperative period in hysteroscopies under general anesthesia. A randomized prospective study.Saudi Med J. 2018; 39: 1017-1022
- Monitoring analgesia.Best Pract Res Clin Anaesthesiol. 2006; 20: 161-180
- Clinical use of the parasympathetic tone activity index as a measurement of postoperative analgaesia in dogs undergoing ovariohysterectomy.J Vet Res. 2021; 65: 117-123
- Validation of the 4AVet postoperative pain scale in dogs and cats.Vet Anaesth Analg. 2010; 37: 1-17
- Evaluation of the analgesia nociception index for monitoring intraoperative analgesia in children.Brit J Anaesth. 2018; 121: 462-468
- Alpha-2 and imidazoline receptor agonists. Their pharmacology and therapeutic role.Anaesthesia. 1999; 54: 146-165
- Surgical pleth index: prospective validation of the score to predict moderate-to-severe postoperative pain.Brit J Anaesth. 2019; 123: 328-332
- PhysioDoloris: A monitoring device for Analgesia/Nociception balance evaluation using Heart Rate Variability analysis.Annu Int Conf IEEE Eng Med Biol Soc. 2010; : 1194-1197
- Evaluation of the Parasympathetic Tone Activity (PTA) index to assess the analgesia/nociception balance in anaesthetised dogs.Res Vet Sci. 2017; 115: 271-277
- Performance of the Parasympathetic Tone Activity (PTA) index to assess the intraoperative nociception using different premedication drugs in anaesthetised dogs.Int J Vet Sci Med. 2020; 8: 49-55
- Performance of the Parasympathetic Tone Activity (PTA) index to predict changes in mean arterial pressure in anaesthetized horses with different health conditions.Res Vet Sci. 2021; 139: 43-50
- Hypercapnia in the critically ill: insights from the bench to the bedside.Interface Focus. 2021; 1120200032
- The effect of carbon dioxide, respiratory rate and tidal volume on human heart rate variability.Acta Anaesthesiol Scand. 2004; 48: 93-101
- The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises.Pain. 2020; 161: 1976-1982
- Antinociception and cardiovascular responses produced by intravenous morphine: the role of vagal afferents.Brain Res. 1991; 543: 256-270
- Central vagal control of fentanyl-induced bradycardia during halothane anesthesia.Anesth Analg. 1978; 57: 31-36
- Utilizing heart rate variability: Midazolam prevents the sympathovagal imbalance caused by fentanyl/propofol induction.Ain-Shams J Anaesthesiol. 2015; 8: 31-35
- The different effects of intravenous propofol and midazolam sedation on hemodynamic and heart rate variability.Anesth Analg. 2005; 101: 97-102
Article info
Publication history
Published online: August 30, 2022
Accepted:
August 22,
2022
Received in revised form:
July 9,
2022
Received:
September 5,
2021
Identification
Copyright
© 2022 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.