Prediction of hemodynamic reactivity by electroencephalographically derived Pain Rating Index in children during general anesthesia: a prospective observational study

Background: Pain rating index (PRI) is a novel measure of nociception based on integrated electroencephalogram parameters during general anesthesia. Wavelet index (WLI) as a sedation index reflects the patient's sedation state. This study aims to evaluate the performance of PRI and WLI to predict hemodynamic reactivity after tracheal intubation and skin incision in pediatric patients. Methods: 134 children undergoing elective general or urinary surgery were analyzed. PRI, WLI, heart rate (HR), and mean blood pressure (MBP) were measured at predefined time-points during tracheal intubation and skin incision. Receiver-operating characteristic (ROC) curves were computed to evaluate the predictive performance of PRI and WLI to measure hemodynamic reactivity (increase by more than 20% of either MBP or HR) during general anesthesia. Results: In 134 patients, positive reactivity of HR and MBP was observed in 95 (70.9%) and 61 (45.5%) patients induced by endotracheal intubation and 19 (14.2%) and 24 (17.9%) patients induced by skin incision. Using either HR or MBP reactivity induced by tracheal intubation as a dichotomous variable, the areas under the curves (AUCs) [95% CI] of PRI and WLI were 0.81[0.73-0.87] and 0.58[0.49-0.67] with the best cutoff values of 62 and 49; The AUCs [95% CI] of PRI and WLI were 0.82[0.75-0.88] and 0.61[0.52-0.69] after skin incision, the best cutoff values of PRI and WLI were 60 and 46, respectively. Conclusions: PRI can predict hemodynamic reactivity with the best cutoff values of 62 and 60 after tracheal intubation and skin incision in pediatric patients during general anesthesia while WLI failed in predicting hemodynamic changes. Trial registration: Chinese Clinical Trial Register (Unique identifier: ChiCTR1800015969, Date of registration: May 3, 2018). Key words: Pain Rating Index, Wavelet index, Hemodynamic reactivity, Pediatric patients

Do Cardiovascular Responses to Active and Passive Coping Tasks predict Future Blood Pressure over a 10-Month Later?

The study examined whether cardiovascular responses to active or passive coping tasks and single or multiple tasks predicted changes in resting blood pressure (BP) over a ten-month period. Heart rate (HR), BP, cardiac output (CO), and total peripheral resistance (TPR) were measured at rest, and during mental stress tests (mental arithmetic, speech, and cold pressor tasks). A total of 104 eligible participants participated in the initial study, and 77 (74.04%) normotensive adult participants’ resting BP were re-evaluated at ten-month follow-up. Regression analyses indicated that after adjustment for baseline BP, initial age, gender, body mass index, family history of cardiovascular disease, and current cigarette smoking, heighted systolic blood pressure (SBP) and HR responses to an active coping task (mental arithmetic) were associated with increased future SBP (ΔR2 = .060, ΔR2 = .045, respectively). Further, aggregated SBP responsivity (over the three tasks) to the predictor models resulted in significant, but smaller increases in ΔR2 accounting for .040 of the variance of follow-up SBP. These findings suggest that cardiovascular responses to active coping tasks predict future SBP. Further, compared with single tasks, the findings revealed that SBP responses to three tasks were less predictive compared to an individual task (i.e., mental arithmetic). Of importance, hemodynamic reactivity (namely CO and TPR) did not predict future BP suggesting that more general psychophysiological processes (e.g., inflammation, platelet aggregation) may be implicated, or that BP, but not hemodynamic reactivity may be a marker of hypertension.