Observational studyJournal of clinical monitoring and computing2026
Pre-induction nociception indices are associated with post-induction hypotension during general anesthesia in older patients: a prospective observational study.
Observational study in Journal of clinical monitoring and computing, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
We investigated whether pre-induction High Frequency Variability Index (HFVI)/Analgesia Nociception Index (ANI) and Nociception Level (NOL) values could predict hypotension during general anesthesia induction in older patients. This prospective observational study included patients aged ≥ 65 years undergoing elective surgery under general anesthesia. After recording HFVI/ANI and NOL values, remifentanil was administered at 0.2 µg/kg/min for 2 min, followed by a rapid intravenous bolus administration of propofol at 2 mg/kg. Noninvasive blood pressure was measured at 1-min intervals over 5 min. Hypotension was defined as mean arterial pressure (MAP) < 65 mmHg. Predictive performance was evaluated using receiver operating characteristic (ROC) curves. Additionally, the area under MAP < 65 mmHg (AUT-65), a continuous metric integrating the depth and duration of hypotension, was calculated and correlated with nociception index values. We analyzed 51 patients (19 men; 22 in the hypotension group and 29 in the nonhypotension group). The hypotension group demonstrated lower HFVI/ANIi values (58.7 ± 11.1 vs. 69.0 ± 15.1, p = 0.010) and higher NOL values (17.2 ± 9.1 vs. 10.7 ± 8.8, p = 0.013). HFVI/ANIi (AUC = 0.72, cutoff = 62.5) and NOL (AUC = 0.71, cutoff = 13.5) moderately predicted hypotension. AUT-65 was significantly correlated with HFVI/ANIi (Spearman rho = - 0.35, p = 0.013) and NOL (rho = 0.47, p = 0.0005). Pre-induction HFVI/ANI and NOL were associated with the occurrence and cumulative burden of post-induction hypotension in patients aged ≥ 65 years, suggesting their potential utility as pre-induction screening tools.Trial registration This study was approved by the Ethics Committee of Yamagata University Hospital on January 18, 2024 (approval number 2023 - 280). Before commencement, the study was registered as a prospective observational study in the UMIN Clinical Trials Registry (UMIN000053529).
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