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Article ; Online: Nociception level: what's in a name?

Nitzschke, Rainer / Fischer, Marlene / Funcke, Sandra

2021 Volume 128, Issue 2, Page(s) e49–e50

MeSH term(s)	Analgesics, Opioid ; Anesthesia, General ; Humans ; Nociception
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2021-11-26
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	80074-0
ISSN	1471-6771 ; 0007-0912
ISSN (online)	1471-6771
ISSN	0007-0912
DOI	10.1016/j.bja.2021.10.034
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Article ; Online: In Reply.

Funcke, Sandra / Nitzschke, Rainer

Anesthesiology

2018 Volume 128, Issue 4, Page(s) 857–858

MeSH term(s)	Anesthesia, General ; Electric Stimulation ; Nociception
Language	English
Publishing date	2018-03-13
Publishing country	United States
Document type	Letter ; Research Support, Non-U.S. Gov't ; Comment
ZDB-ID	269-0
ISSN	1528-1175 ; 0003-3022
ISSN (online)	1528-1175
ISSN	0003-3022
DOI	10.1097/ALN.0000000000002101
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Article ; Online: Nozizeptionsmonitoring : Methode zur intraoperativen Opioidsteuerung?

Nitzschke, Rainer / Fischer, Marlene / Funcke, Sandra

Der Anaesthesist

2021 Volume 70, Issue 9, Page(s) 735–752

Abstract: The intraoperative dosing of opioids is a challenge in routine anesthesia as the potential effects of intraoperative overdosing and underdosing are not completely understood. In recent years an increasing number of monitors were approved, which were ... ...

Title translation	Nociception monitoring : Method for intraoperative opioid control?
Abstract	The intraoperative dosing of opioids is a challenge in routine anesthesia as the potential effects of intraoperative overdosing and underdosing are not completely understood. In recent years an increasing number of monitors were approved, which were developed for the detection of intraoperative nociception and therefore should enable a better control of opioid titration. The nociception monitoring devices use either continuous hemodynamic, galvanic or thermal biosignals reflecting the balance between parasympathetic and sympathetic activity, measure the pupil dilatation reflex or the nociceptive flexor reflex as a reflexive response to application of standardized nociceptive stimulation. This review article presents the currently available nociception monitors. Most of these monitoring devices detect nociceptive stimulations with higher sensitivity and specificity than changes in heart rate, blood pressure or sedation depth monitoring devices. There are only few studies on the effect of opioid titration guided by nociception monitoring and the possible postoperative benefits of these devices. All nociception monitoring techniques are subject to specific limitations either due to perioperative confounders (e.g. hypovolemia) or special accompanying medical conditions (e.g. muscle relaxation). There is an ongoing discussion about the clinical relevance of nociceptive stimulation in general anesthesia and the effect on patient outcome. Initial results for individual monitor systems show a reduction in opioid consumption and in postoperative pain level. Nevertheless, current evidence does not enable the routine use of nociception monitoring devices to be recommended as a clear beneficial effect on long-term outcome has not yet been proven.
MeSH term(s)	Analgesia ; Analgesics, Opioid ; Anesthesia, General ; Humans ; Monitoring, Intraoperative ; Nociception
Chemical Substances	Analgesics, Opioid
Language	German
Publishing date	2021-08-23
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	260-4
ISSN	1432-055X ; 0003-2417
ISSN (online)	1432-055X
ISSN	0003-2417
DOI	10.1007/s00101-021-01022-6
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Article ; Online: Validation of three nociception indices to predict immediate postoperative pain before emergence from general anaesthesia: a prospective double-blind, observational study.

Koschmieder, Kim C / Funcke, Sandra / Shadloo, Mahshid / Pinnschmidt, Hans O / Greiwe, Gillis / Fischer, Marlene / Nitzschke, Rainer

British journal of anaesthesia

2023 Volume 130, Issue 4, Page(s) 477–484

Abstract: Background: Nociception monitoring devices are designed to estimate nociception during general anaesthesia. We evaluated the predictive accuracy of heart rate and three nociception indices to predict postoperative pain before emergence from general ... ...

Abstract	Background: Nociception monitoring devices are designed to estimate nociception during general anaesthesia. We evaluated the predictive accuracy of heart rate and three nociception indices to predict postoperative pain before emergence from general anaesthesia. Methods: In patients undergoing trauma or orthopaedic surgery, HR, Surgical Pleth Index® (SPI), Pupillary Pain Index® (PPI), and Nociception Level® (NOL) were simultaneously recorded for 5 min after the end of surgery but before return of consciousness. After admission to the recovery room, pain scores were assessed regularly for 2 h. HR, SPI, PPI, and NOL were analysed for their predictive accuracy of postoperative pain and opioid consumption with assessment of area under the receiver operating characteristic (AUC) curves, Spearman rank-correlation coefficient, and regression modelling. Results: Data for 60 subjects were analysed. The AUC (95% confidence interval [95% CI]) of the predictive accuracy for moderate-to-severe postoperative pain differed between nociception indices (HR=0.46 [0.29-0.64], P=0.671; SPI=0.46 [0.31-0.61], P=0.621; PPI=0.52 [0.36-0.68], P=0.770; NOL=0.66 [0.51-0.81], P=0.038). In a multivariable logistic regression model, a higher predictive accuracy was found for a multivariable predictor combining NOL values with ASA physical status and information about use of regional anaesthesia (AUC=0.83 [0.72-0.94], P<0.001). Conclusions: Heart rate, Surgical Pleth Index, Pupillary Pain Index, and Nociception Level measured before emergence from general anaesthesia do not yet have sufficient diagnostic accuracy for prediction of postoperative pain. Clinical trial registration: NCT05063227.
MeSH term(s)	Humans ; Nociception/physiology ; Prospective Studies ; Monitoring, Intraoperative ; Pain, Postoperative/diagnosis ; Anesthesia, General
Language	English
Publishing date	2023-01-04
Publishing country	England
Document type	Observational Study ; Randomized Controlled Trial ; Journal Article
ZDB-ID	80074-0
ISSN	1471-6771 ; 0007-0912
ISSN (online)	1471-6771
ISSN	0007-0912
DOI	10.1016/j.bja.2022.11.024
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Book ; Online ; Thesis: Kardioprotektive Eigenschaften von Xenon und Isofluran auf den myokardialen Ischämie-Reperfusions-Schaden der Ratte

Funcke, Sandra

2012

Author's details	vorgelegt von Sandra Funcke
Language	German
Size	Online-Ressource (Online-Ressource)
Document type	Book ; Online ; Thesis
Thesis / German Habilitation thesis	Techn. Hochsch., Diss.--Aachen, 2012
Database	Special collection on veterinary medicine and general parasitology

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Book ; Online ; Thesis: Nozizeptionsmonitor-gesteuerte Analgesie während Allgemeinanästhesie

Brinkmann, Charlotte Maren [Verfasser] / Funcke, Sandra Akademischer Betreuer] / [Nitzschke, Rainer [Akademischer Betreuer]

2021

Author's details	Charlotte Maren Brinkmann ; Sandra Funcke, Rainer Nitzschke
Keywords	Medizin, Gesundheit ; Medicine, Health
Subject code	sg610
Language	German
Publisher	Staats- und Universitätsbibliothek Hamburg Carl von Ossietzky
Publishing place	Hamburg
Document type	Book ; Online ; Thesis
Database	Digital theses on the web

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Article: The impact of spinal anaesthesia on perioperative opioid consumption, postoperative pain and oncological outcome in radical retropubic prostatectomy-a retrospective before-and-after effectiveness study.

Funcke, Sandra / Schick-Bengardt, Xenia / Pinnschmidt, Hans O / Beyer, Burkhard / Fischer, Marlene / Kahl, Ursula / Nitzschke, Rainer

Perioperative medicine (London, England)

2022 Volume 11, Issue 1, Page(s) 49

Abstract: Background: Spinal anaesthesia preceding general anaesthesia has been conducted for open radical retropubic prostatectomy (RRP) to decrease immediate postoperative pain for many years. Nevertheless, the effectiveness of spinal anaesthesia to reduce ... ...

Abstract	Background: Spinal anaesthesia preceding general anaesthesia has been conducted for open radical retropubic prostatectomy (RRP) to decrease immediate postoperative pain for many years. Nevertheless, the effectiveness of spinal anaesthesia to reduce postoperative opioid requirements remains unknown. The aim of the present study was to determine the effect of spinal anaesthesia preceding general anaesthesia on opioid requirements, postoperative pain and biochemical cancer-free survival. Methods: This before-and-after effectiveness study investigated effects of two different anaesthesia techniques in 636 patients with RRP. Three hundred eighteen consecutive patients in the SPA group (spinal anaesthesia preceding general anaesthesia) were compared with 318 patients in the GA group (general anaesthesia alone). The primary endpoint of the study was opioid consumption in the post-anaesthesia care unit. Secondary endpoints were intraoperative opioid consumption, postoperative pain, postoperative recovery time, the length of hospital-stay, persistence of pain 1 year after surgery and cancer-free survival. Differences between the groups were analysed by a two-sided t-test, χ Results: The total amount of morphine equivalent administered postoperatively was 7.5 [6.9; 8.1] mg in the SPA group and 6.0 [5.5; 6.5] mg in the GA group (mean [95% CI], p < 0.001). The amount of intraoperative sufentanil was 56.9 [55.1; 58.7] μg in the SPA group and 84.5 [82.5; 86.5] μg in the GA group (mean [95% CI], p < 0.001). There was no difference found in the postoperative pain level, length of hospital-stay and pain level 1 year after surgery. Biochemical cancer-free survival was highly related to TNM stage (p < 0.001, pT3 vs. pT2 hazard ratio 5.4 [95%CI 3.3; 9.2]) but not to the type of anaesthesia (p = 0.29). Conclusions: Spinal anaesthesia preceding general anaesthesia for RRP is associated with increased postoperative opioid consumption compared to general anaesthesia alone. Postoperative pain level and the oncological outcome are not affected by the adjunctive use of spinal anaesthesia. Thus, the addition of spinal anaesthesia to general anaesthesia has no advantage in RRP. Trial registration: ClinicalTrial.gov, NCT03565705.
Language	English
Publishing date	2022-10-03
Publishing country	England
Document type	Journal Article
ZDB-ID	2683800-X
ISSN	2047-0525
ISSN	2047-0525
DOI	10.1186/s13741-022-00281-0
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Article ; Online: Effect of thoracic epidural anesthesia on postoperative outcome in major liver surgery: a retrospective cohort study.

Behem, Christoph R / Wegner, Juliane C / Pinnschmidt, Hans O / Greiwe, Gillis / Graessler, Michael F / Funcke, Sandra / Nitzschke, Rainer / Trepte, Constantin J C / Haas, Sebastian A

Langenbeck's archives of surgery

2023 Volume 408, Issue 1, Page(s) 168

Abstract: Purpose: Postoperative complications after major liver surgery are common. Thoracic epidural anesthesia may provide beneficial effects on postoperative outcome. We strove to compare postoperative outcomes in major liver surgery patients with and without ...

Abstract	Purpose: Postoperative complications after major liver surgery are common. Thoracic epidural anesthesia may provide beneficial effects on postoperative outcome. We strove to compare postoperative outcomes in major liver surgery patients with and without thoracic epidural anesthesia. Methods: This was a retrospective cohort study in a single university medical center. Patients undergoing elective major liver surgery between April 2012 and December 2016 were eligible for inclusion. We divided patients into two groups according to whether or not they had thoracic epidural anesthesia for major liver surgery. The primary outcome was postoperative hospital length of stay, i.e., from day of surgery until hospital discharge. Secondary outcomes included 30-day postoperative mortality and major postoperative complications. Additionally, we investigated the effect of thoracic epidural anesthesia on perioperative analgesia doses and the safety of thoracic epidural anesthesia. Results: Of 328 patients included in this study, 177 (54.3%) received thoracic epidural anesthesia. There were no clinically important differences in postoperative hospital length of stay (11.0 [7.00-17.0] vs. 9.00 [7.00-14.0] days, p = 0.316, primary outcome), death (0.0 vs. 2.7%, p = 0.995), or the incidence of postoperative renal failure (0.6 vs. 0.0%, p = 0.99), sepsis (0.0 vs. 1.3%, p = 0.21), or pulmonary embolism (0.6 vs. 1.4%, p = 0.59) between patients with or without thoracic epidural anesthesia. Perioperative analgesia doses - including the intraoperative sufentanil dose (0.228 [0.170-0.332] vs. 0.405 [0.315-0.565] μg·kg Conclusion: This retrospective analysis suggests that thoracic epidural anesthesia does not reduce postoperative hospital length of stay in patients undergoing major liver surgery - but it may reduce perioperative analgesia doses. Thoracic epidural anesthesia was safe in this cohort of patients undergoing major liver surgery. These findings need to be confirmed in robust clinical trials.
MeSH term(s)	Humans ; Retrospective Studies ; Pain, Postoperative/drug therapy ; Pain, Postoperative/prevention & control ; Length of Stay ; Anesthesia, Epidural ; Postoperative Complications/epidemiology ; Postoperative Complications/prevention & control ; Liver ; Analgesia, Epidural
Language	English
Publishing date	2023-04-29
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1423681-3
ISSN	1435-2451 ; 1435-2443
ISSN (online)	1435-2451
ISSN	1435-2443
DOI	10.1007/s00423-023-02900-w
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Book ; Online ; Thesis: Kardioprotektive Eigenschaften von Xenon und Isofluran auf den myokardialen Ischämie-Reperfusions-Schaden der Ratte

Funcke, Sandra [Verfasser]

2012

Author's details	Sandra Funcke
Keywords	Medizin, Gesundheit ; Medicine, Health
Subject code	sg610
Language	German
Publisher	Hochschulbibliothek der Rheinisch-Westfälischen Technischen Hochschule Aachen
Publishing place	Aachen
Document type	Book ; Online ; Thesis
Database	Digital theses on the web

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Article ; Online: Exploring the Latent Structure and Convergent and Incremental Validity of the Metacognition Assessment Scale - Abbreviated in a Sample of Patients with Non-Affective Psychosis.

Bröcker, Anna-Lena / Zimmermann, Johannes / Stuke, Frauke / Just, Sandra / Bayer, Samuel / Mielau, Juliane / Bertram, Gianna / Funcke, Jakob / Maaßen, Eva / Hadzibegovic, Jasmina / Lempa, Günter / von Haebler, Dorothea / Montag, Christiane

Journal of personality assessment

2022 Volume 105, Issue 1, Page(s) 100–110

Abstract: Synthetic metacognition is a heterogeneous construct related to psychotic disorders. One important tool to assess this construct is the Metacognition Assessment Scale - Abbreviated (MAS-A). In this study, we investigated the latent structure as well as ... ...

Abstract	Synthetic metacognition is a heterogeneous construct related to psychotic disorders. One important tool to assess this construct is the Metacognition Assessment Scale - Abbreviated (MAS-A). In this study, we investigated the latent structure as well as the interrater reliability and convergent and incremental validity of the MAS-A in a sample of patients with non-affective psychosis. Analyses indicated that the scale might be one-dimensional. Interrater reliability of the MAS-A total score was good. In terms of convergent validity, correlational analyses showed significant associations of MAS-A metacognition with the Operationalized Psychodynamic Diagnosis Level of Structural Integration Axis (OPD-LSIA) and the Levels of Emotional Awareness Scale (LEAS). In terms of construct validity, a significant association was observed between MAS-A metacognition and a short version of the International Classification of Functioning, Disability and Health (MINI-ICF), which persisted after self-report measures of impairments in structural capacities (Structure Questionnaire of Operationalized Psychodynamic Diagnosis [OPD-SQS]) and mentalizing abilities (Mentalization Questionnaire [MZQ]) were included as covariates, but not after symptom dimensions were included. There was a significant correlation with the current living situation, but not with other external criteria like diagnosis or duration of illness. Future studies should explore alternative outcomes and replicate results in longitudinal designs.
MeSH term(s)	Humans ; Metacognition ; Reproducibility of Results ; Psychotic Disorders/diagnosis ; Psychotic Disorders/psychology ; Surveys and Questionnaires ; Self Report
Language	English
Publishing date	2022-04-01
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	121962-5
ISSN	1532-7752 ; 0022-3891
ISSN (online)	1532-7752
ISSN	0022-3891
DOI	10.1080/00223891.2022.2048843
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