Analgesia Nociception Index-Guided Remifentanil versus Standard Care during Propofol Anesthesia: A Randomized Controlled Trial

The clinical benefits to be expected from intraoperative nociception monitors are currently under investigation. Among these devices, the Analgesia Nociception-Index (ANI) has shown promising results under sevoflurane anesthesia. Our study investigated ANI-guided remifentanil administration under propofol anesthesia. We hypothesized that ANI guidance would result in reduced remifentanil consumption compared with standard management. This prospective, randomized, controlled, single-blinded, bi-centric study included women undergoing elective gynecologic surgery under target-controlled infusion of propofol and remifentanil. Patients were randomly assigned to an ANI or Standard group. In the ANI group, remifentanil target concentration was adjusted by 0.5 ng mL−1 steps every 5 min according to the ANI value. In the Standard group, remifentanil was managed according to standard practice. Our primary objective was to compare remifentanil consumption between the groups. Our secondary objectives were to compare the quality of anesthesia, postoperative analgesia and the incidence of chronic pain. Eighty patients were included. Remifentanil consumption was lower in the ANI group: 4.4 (3.3; 5.7) vs. 5.8 (4.9; 7.1) µg kg−1 h−1 (difference = −1.4 (95% CI, −2.6 to −0.2), p = 0.0026). Propofol consumption was not different between the groups. Postoperative pain scores were low in both groups. There was no difference in morphine consumption 24 h after surgery. The proportion of patients reporting pain 3 months after surgery was 18.8% in the ANI group and 30.8% in the Standard group (difference = −12.0 (95% CI, −32.2 to 9.2)). ANI guidance resulted in lower remifentanil consumption compared with standard practice under propofol anesthesia. There was no difference in short- or long-term postoperative analgesia.

Adopting a Modern Dev+Ops Model

Modern Dev+Ops is allowing organizations to meet the evolving needs of their customers faster and more consistently by closing the gap between dev and ops functions.Companies of all shapes and sizes have tossed aside waterfall product management cycles and embraced agile and DevOps for the promise of faster innovation, improved security, performance, and resilience, as well as happier developers and customers. But even with all of the benefits of DevOps, it isn’t perfect. DevOps came into existence before developing and hosting applications in the cloud was a standard practice, and though it has been around for a long time, it is still largely open to interpretation from one organization to the other. For example, many organizations still consider DevOps to be a dedicated team, and in other cases, it can mean developers doing all of the operations work. As technology has evolved, so has our definition of DevOps. We call this approach Modern Dev+Ops, andit is centered around bringing developers and operations closer by sharing operational tasks like compliance, observability, resilience, and infrastructure earlier into the development process and enhancing it with AI/ML.