Monitorering av nociception – Är höger eller vänster sida att föredra?

Detta är en Magister-uppsats från

Sammanfattning: Background: Today elderly and patients with complex diseases undergo anesthesia which used to be impossible. These patients often require pharmaceuticals which complicate the assessment of intraoperative nociception. It is difficult for health-care professionals to assess pain in awake patients, a task even more difficult whilst undergoing general anesthesia. Insufficient pain treatment could lead to negative consequences for both the patient and society. Monitors that measure nociception have been developed to optimize and individualize pain assessment intraoperatively. One of these monitors is called PMD-200 and uses physiological variables to compute NoL-index as measurement of nociception.Aim: The aim of this study is to investigate whether bilaterally placed NoL sensors measures nociceptive stimulus likewise in patients undergoing general anesthesia.Method: A quantitative non-experimental observational study was conducted. Eight patients were included through a convenience sampling based on the inclusion criteria. Prechosen nociceptive stimulus such as jaw-thrust, intubation and skin incision were observed alongside the insertion of urinary catheter, nasogastric tube and arterial line using the PMD-200 monitor. NoL-index registered on the left and right hand was documented along with vital signs to be compared and presented in descriptive statistics.Results: NoL-index differed during the prechosen stimulus when compared both individually and collectively. A difference in NoL-index between the right and left side was more frequent than equal measuring. The difference in mean between right and left NoL-index was the highest during insertion of an arterial line and the lowest during skin incision. Between mean arterial pressure (MAP) and heartrate, the MAP seems to correlate better with the NoL-index. The results indicate a higher NoL-index in the same arm as ongoing non-invasiv blood pressure measurement.Conclusion: A certain difference in between right and left NoL index was detected during this observational study. Unfortunately, no conclusions have been made whether the differences were of statistical significance. Further studies are required.

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