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Related Concept Videos

Nociception01:44

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Local anesthetics (LAs) block the sodium channels of nerve trunks, sensory nerve endings, and neuromuscular junctions. Although LAs can block all kinds of nerves, the sensitivity of nerve fibers differs according to nerve types and structures. LAs are known to block myelinated fibers faster than unmyelinated ones. Also, they block pain or sensory neurons at low concentrations without affecting the motor neurons involved in muscle contractions. This helps relieve labor pain without affecting the...
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Mechanically-gated ion channels are proteins found in eukaryotic and prokaryotic cell membranes that open in response to mechanical stress. Tension, compression, swelling, and shear stress can alter the conformation of the protein, opening a transmembrane channel that allows the passage of ions for signal transmission. In eukaryotes, mechanically-gated channels are distributed in several regions like the neurons, lungs, skin, bladder, and heart, where they play critical roles in numerous...
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Pulse amplitude and quality01:17

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Pulse amplitude is a crucial indicator of cardiac health because it provides valuable insights into the strength of left ventricular contractions and the overall uniformity of blood circulation within the vasculature. The strength of the pulse is directly related to the force with which the heart contracts and the volume of blood being pumped.
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Sound Intensity Level00:53

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Humans perceive sound by hearing. The human ear helps sound waves reach the brain, which then interprets the waves and creates the perception of hearing. The loudness of the environment in which a person is located determines whether they can distinguish between different sound sources.
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Sensory Functions of the Skin01:16

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The skin is the largest organ of the human body and plays a crucial role in our sensory perception. It contains a vast network of sensory receptors that contribute to the skin's protective function by perceiving physical, biological, and environmental cues and generating relevant responses.
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Related Experiment Video

Updated: Jan 12, 2026

Objective Nociceptive Assessment in Ventilated ICU Patients: A Feasibility Study Using Pupillometry and the Nociceptive Flexion Reflex
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Objective Nociceptive Assessment in Ventilated ICU Patients: A Feasibility Study Using Pupillometry and the Nociceptive Flexion Reflex

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Nociception level index response to pacemaker stimulation.

Cosmin Balan1, Robert-Thomas Barbulescu2, Andrei Dumitrache2

  • 11 st Department of Cardiovascular Anesthesia and Intensive Care Medicine, Prof. Dr. C.C. Iliescu Institute for Emergency Cardiovascular Diseases, Bucharest, Romania. cosmin13mara@yahoo.com.

Journal of Clinical Monitoring and Computing
|November 3, 2025
PubMed
Summary
This summary is machine-generated.

The Nociception Level (NOL) index is affected by pacemaker interference. Recalibrating the PMD-200™ monitor to the paced heart rate accurately reflects nociception-antinociception balance during pacemaker stimulation.

Keywords:
Cardiac surgeryNociception level indexNociception-antinociception balancePacemaker

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Area of Science:

  • Anesthesiology
  • Cardiovascular Anesthesia
  • Intraoperative Monitoring

Background:

  • The Nociception Level (NOL) index, derived from photoplethysmography, assesses intraoperative nociception-antinociception balance.
  • Pacemaker interference may impact NOL index accuracy due to its reliance on photoplethysmography.

Purpose of the Study:

  • To evaluate the response of the NOL index to pacemaker stimulation in the absence of nociceptive input.
  • To determine if recalibration of the PMD-200™ monitor can mitigate pacemaker interference with NOL index readings.

Main Methods:

  • Adults undergoing elective cardiac surgery and receiving mechanical ventilation were studied.
  • NOL index, bispectral index, mean arterial pressure, and heart rate were recorded during sequential periods of pacemaker off, pacing at 90 and 110 beats/min, and after recalibration.
  • Data were analyzed using mixed-model repeated measures with the bispectral index as a covariate.

Main Results:

  • Pacemaker stimulation significantly affected NOL index values over time (p < 0.001).
  • NOL index increased from baseline (2.1) to 8.4 at 90 bpm and 18.4 at 110 bpm pacing.
  • Recalibration of the PMD-200™ monitor to the paced rate (110 bpm) restored NOL index to baseline levels (1.1), maintaining stability.

Conclusions:

  • The NOL index is significantly influenced by pacemaker stimulation.
  • Recalibration of the PMD-200™ monitor to the paced heart rate allows for accurate assessment of nociception-antinociception balance during pacemaker use.
  • This finding is crucial for reliable intraoperative monitoring in patients with pacemakers.