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

Abstract 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