Pain and Stress Measurement During General Anesthesia Using the Respiratory Sinus Arrhythmia

Janosch Frederic Kunczik, Marucs Koeny, Czaplik Michael, Vladimir Blazcek, Steffen Leonhardt


Measuring intraoperative pain and stress during general anesthesia is still problematic. Instead of having access to meaningful and robust pain measurements, anesthetists must use their experience and intuition to ensure a proper pain therapy. The correct dosage of analgesics is crucial for a stable patient, since underdosing may lead to neurogenic shock. Overdosing can result in critically low blood pressures and heart rates.

Several possible approaches towards measuring pain have been proposed in the last years. We briefly summarize them and evaluate their usability in a general anesthesia setting. A promising approach is given by the Analgesia Nociception Index. We developed an advanced algorithm, called the Surgical Analgesia Index, which improves its concept for the use in a fully connected smart operating room. This paper is dedicated to its description, preliminary validation and comparison against the original index.


Pain; Respiratory Sinus Arrhythmia; Heart Rate Variability; Analgesia Nociception Index; Surgical Analgesia Index

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This work is licensed under a Creative Commons Attribution 4.0 International License.

ISSN 0301-5491 (Print)
ISSN 2336-5552 (Online)
Published by the Czech Society for Biomedical Engineering and Medical Informatics and the Faculty of Biomedical Engineering, Czech Technical University in Prague.