Analgesia Nociception Index (ANI) to predict intraoperative haemodynamic changes: results of a pilot investigation

Acta Anaesthesiol Scand. 2014 Jan;58(1):74-9. doi: 10.1111/aas.12216. Epub 2013 Oct 25.


Background: The Analgesia Nociception Index has been described to reflect different levels of intraoperative nociceptive stimulation during total intravenous anaesthesia. The association between this index and haemodynamic changes during sevoflurane-based anaesthesia was investigated in 30 patients with the hypothesis that changes in the Analgesia Nociception Index may coincide with or even predict haemodynamic changes.

Methods: The Analgesia Nociception Index as well as blood pressure and heart rate were observed during induction, at skin incision, at times of an Analgesia Noceception Index decrease > 20% ('event') and pre-/post-fentanyl administration.

Results: The Analgesia Nociception Index decreased with airway manipulation [mean: 52 (before) vs. 33 (after); P < 0.005] and after skin incision [mean: 63 (before) vs. 38 (after); P < 0.001], and it increased after fentanyl administration [53 (before) vs. 59 (after); P < 0.05]. However, its predictive probability to indicate heart rate and blood pressure increases of >10% was low (heart rate 0.61; blood pressure 0.59).

Conclusions: The Analgesia Nociception Index appears to reflect different levels of stimulation during sevoflurane-based general anaesthesia. However, it was of little predictive value to pre-empt significant haemodynamic changes.

MeSH terms

  • Adult
  • Aged
  • Analgesia*
  • Anesthesia, General
  • Anesthetics, Inhalation
  • Blood Pressure / physiology
  • Female
  • Heart Rate / physiology
  • Hemodynamics / physiology*
  • Humans
  • Intraoperative Period*
  • Male
  • Methyl Ethers
  • Middle Aged
  • Monitoring, Intraoperative
  • Nociception / physiology*
  • Pilot Projects
  • Predictive Value of Tests
  • Sevoflurane
  • Surgical Procedures, Operative


  • Anesthetics, Inhalation
  • Methyl Ethers
  • Sevoflurane