Heart rate variability is a well-known phenomenon that controls the regulation of the cardiovascular system via the autonomic nervous system. By analysing the heart rate variability oscillations it reflects the activity of the sympathetic and parasympathetic nervous systems.
All mammals exhibit what is known as respiratory sinus arrhythmia.The latter process is controlled by the sympathetic and the parasympathetic branch of the n.accumbens and ambiguus, causing the heart to beat slower during expiration due to vagal activation and faster in inspiration as a result of sympathetic inner vation.
TheANIexpressinpercentagetheparasympathetic activity of the patient. Thus, an ANI of 50 means that 50% of the total energy of the ANS is related to parasympathetic.
The total energy of the ANS is shown in the screen of the monitor.
During general anaesthesia the ANI range [50- 70] relates to adequate analgesia, which means that antinociception is adequate and that the parasympathetic activity is mildly predominant over sympathetic activity.
When the ANI value falls below 50, the occurrence of a hemodynamic response within the following 10 minutes is very likely.(8) Anesthesists can use this information in order to predict and avoid a hemodynamic response by increasing analgesia.
The NIPE technology enables an objective and continuous measurement of the parasympathetic component of the Autonomous Nervous System in babies and young infants. The unique technology has efficacy proven to work with extremely premature babies from around 26 weeks gestation through to infants up to two years of age and is based on the electrocardiogram taken from the patient monitor in use.
Continuous and non - invasive measurement -No additional sensors required and real-time analysis.
Easy to interpret - A simple digital scale - the higher the index, the more comfortable the patient. Dual indexes: averaged value (NIPEm) for chronic or prolonged pain and instantaneous reading (NIPEi) for acute pain.
Evaluation of comfort and discomfort with NIPEm - Monitoring with NIPEm allows nursing staff to observe the impact of environmental conditions such as noise, light, positioning, choice of face-mask, etc. and optimise for the individual patient. (Kuissi 2009, JFRN - Rethore 2011, JFRN) The positive influences generated by developmental care activities such as parental contact, cocooning, kangaroo care, etc. can be quantified, reinforcing the benefits and encouraging family centred care. (Alexandre 2013, Arch Pediatr - Blouin 2014, JFRN)
Evaluation of prolonged pain with NIPEm - The treatment before and during a potentially painful or stressful procedure in the NICU, including medication, can be adapted by monitoring the NIPEi index. The system can also be used to adapt analgesia protocols to the individual patient’s needs intraoperatively, to avoid the risk of over or under dosage and associated side effects. (Faye 2010, Clin J Pain - De Jonckheere 2011, Conf Proc IEEE Eng Med Biol Soc - Rakza 2011, JFRN - Blouin 2014, JFRN)
Evaluation of acute pain with NIPEi - Used to adapt pain-relief (with or without drugs) before a potentially painful and/or stressful procedure in the NICU. Used to personalize the administration of pain killers during surgery in order to avoid over and under dosage and their side effects.