Reducing the quantity of morphinomimetics during the operative period reduces the prevalence and intensity of adverse effects.
However, morphinomimetics are indispensable during surgery, as they limit the autonomic nervous system's deleterious reactions to nociception. The administration of these drugs in intravenous boluses during surgery is usually guided by their duration of action and by variations in heart rate and blood pressure. Other events, such as hypovolemia or extreme surgical position, may stimulate the autonomic nervous system outside of nociception. These events, along with routine drug administration, can lead to undue consumption of morphinomimetics.
The Nol index, a multiparametric monitor of nociception, is based on analysis of variations in plethysmography waveform, heart rate and skin conductance. It has been demonstrated that the use of this type of monitor can reduce intraoperative consumption of morphinomimetics and optimize their administration. Does intraoperative morphinomimetic administration optimized by the NOL index have an impact on the occurrence of dose-dependent adverse effects?
Male or female
Subject aged ≥ 18 years
Affiliated with a social security scheme
Having given written informed consent to participate study
Contraindication to one of the drugs used for anesthesia
Urgent surgery
Intracranial surgery
Transplant surgery
Parallel
Nol index
Procedure/SurgeryMorphinomimetics will be administered according to NOL Index values or according to the usual criteria.
Composite outcome including at least one occurrence of hypoxemia, of nausea-vomiting or of ileus.
1. occurrence of hypoxemia: at least 1 episode of SpO2 \< 95%, 2. occurrence of nausea-vomiting: at least one episode of nausea requiring antiemetic treatment, or at least one episode of vomiting, 3. occurrence of ileus: absence of gas or stool.
Total consumption of intraoperative morphinomimetics
Total consumption of intraoperative vasoconstrictors
type of vasoconstrictor, amount of vasaoconstrictor used and number of boli of vasoconstrictor will be considered
Time of extubation
Delay between the end of the hypnotic infusion and the patient becoming conscious and able to breathe freely
Time from extubation to theoretical post-anesthesia care unit discharge time with Aldrete score at 10
Aldrete's score will be assessed every 5 minutes during his stay in the post-anesthesia care unit. Discharge from the post-anesthesia care unit will be possible when the Aldrete score reaches 10.
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