Predictive value of surgical pleth index for early postoperative pain in children undergoing general anesthesia: a prospective observational study
Bibliographic record
Abstract
BACKGROUND: Postoperative pain is common in children during early recovering from general anesthesia, especially for pediatric patients undergoing adenotonsillectomy surgery. There is no valid tool to predict postoperative pain at present. METHODS: One hundred and fifty patients aged 4–8 years, scheduled to undergo adenotonsillectomy surgery were enrolled in the clinical trial. All patients were given intravenous general anesthesia and endotracheal intubation by the same pediatric anesthesiologist. Surgical pleth index (SPI) monitoring for each patient was performed from the same shared SpO2 measurement finger which was on the side opposite to the NIBP measurement through the CARESCAPE Monitor B650 (GE Healthcare, Helsinki, Finland). The SPI values, mean arterial pressure (MAP) and heart rate (HR) were recorded at each minute for five minutes immediately after surgery. The maximum values of SPI, MAP and HR (SPImax, MAPmax and HRmax respectively) were taken for analysis. Early postoperative pain was assessed for each patient using the modified Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS) in postanesthesia care unit (PACU). Receiver-operating characteristics (ROC) curves and the associated areas under the curves (AUC) were computed to analyze the ability of SPI to predict early postoperative pain. RESULTS: One hundred and thirty-two patients were included and analyzed finally. The SPImax, MAPmax and HRmax of the patients whose CHEOPS scores less than 4 were 43 ± 6, 58 ± 9mmHg and 90 ± 12 beat/min while of the patients whose CHEOPS scores equal or greater than 4 were 54 ± 8, 67 ± 11mmHg and 96 ± 13 beat/min respectively. The SPI (AUC: 0.84, 95% CI: 0.74–0.92, P < 0.001) had a good predictive value for postoperative moderate-to-severe pain compared with MAP (AUC: 0.53, 95% CI: 0.41–0.67, P = 0.58) and HR (AUC: 0.62, 95% CI: 0.46–0.76, P = 0.19). The best-fit (highest combined sensitivity and specificity ) cut-off values of SPI to distinguish mild pain from moderate-to-severe pain was 46 with the sensitivity of 79.4% and specificity of 87.8%. CONCLUSIONS: SPI can effectively predict the occurrence of early postoperative moderate-to-severe pain in pediatric patients undergoing adenotonsillectomy surgery under general anesthesia. SPI might be one reliable pain assessment tool to guide pediatric anesthesiologists for timely identification and management of postoperative pain. TRIAL REGISTRATION: Chinese Clinical Trial Registry, identifier: ChiCTR2200058658 (13/04/2022).
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".