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Nociception monitoring tools using autonomic tone changes for intraoperative analgesic guidance in pediatric patients
Anesth Pain Med 2019;14(4):380-92
Published online October 31, 2019
© 2019 Korean Society of Neuroscience in Anesthesiology and Critical Care.

Byung Gun Lim
Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Korea
Correspondence to: Byung Gun Lim, M.D., Ph.D. Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Gurogu, Seoul 08308, Korea Tel: 82-2-2626-3231 Fax: 82-2-2626-1438 E-mail:
Received September 30, 2019; Accepted September 30, 2019.
cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Nociception monitoring devices using changes in autonomic nervous system activity have been developed in numerous ways. Although there have been few studies conducted on children, compared to the relatively higher number of studies on adults, most of the nociception monitors in children, as in adults, appear to be more useful than the standard clinical practice that uses hemodynamic parameters in the evaluation and treatment of intraoperative nociception (pain) during general anesthesia. Particularly, when monitoring the surgical pleth index (SPI) in anesthetized children, the application of a new target range of SPI values (≤ 40) to the SPI monitoring criteria seems to be necessary for providing a more proper intraoperative analgesia. The analgesia nociception index (ANI) shows promising results in anesthetized adults, and recently, positive results along with cardiorespiratory coherence have been reported in pediatric patients. Newborn infant parasympathetic evaluation (NIPE) could be useful for providing adequate analgesia in newborns, infants, and children under 2 years of age in anesthetized or awake states. In cases of skin conductance and pupillometry, further studies are needed. Understanding the pros, cons, and limitations of these nociception monitoring tools will provide more effective and safe intraoperative analgesia to pediatric patients undergoing general anesthesia, and it may also help to plan and conduct promising research on the use of perioperative nociception monitoring in pediatric patients in the future.
Key Words : Analgesia; Anesthesia, general; Autonomic nervous system; Children; Monitoring, intraoperative; Nociception test; Pain measurement.

October 2019, 14 (4)