The measurement of parasympathetic tone with ANI to continuously evaluate the level of analgesic comfort of the patient, optimizes the consumption of opiates, achieves adequate analgesia, and with a high negative predictive value that helps to differentiate the etiology of hemodynamic adverse events in the ICU mainly in patients under mechanical ventilation. It allows managing individualized doses to each patient managing to avoid sub or supratherapeutic doses, which has been of particular relevance during the COVID-19 pandemic due to the decrease in the supply of medicines for sedoanalgesia.

ANI monitor is very useful for monitoring the patient’s autonomic nervous system, especially in those undergoing mechanical ventilation, to titrate analgosedation.

We are implementing the use of ANI in our critically ill patients, in particular in those being unconscious and/or on muscle paralyzers. Ongoing studies will help to understand how ANI can be useful to estimated nociception in this setting

I found the ANI and NIPE monitors extremely useful specially in the following siutations:

a) To easily and continuously monitor the comfort /distress balance in children.

b)To detect nociception in those patients without any alternative with scales like in deeply sedated and neuromuscular blocked patients.

Using ANI and NIPE in my daily practice, I am able to titrate the analgesics more efficiently in my pediatric patients.

Learning how to use ANI together with BIS to adjust sedation propofol and analgesic with remifentanil in patients with severe fascitis necrosis. This is very useful to titrate adequality those drugs to keep the patient comfortable.