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Journal of Clinical Monitoring and Computing· 2026Q2

Nociception monitoring during cardiac surgery with cardiopulmonary bypass: limitations and future directions

Vladislav Rogozov, Tomáš Vaněk, Zuzana Blažejová

Short summary

Nociception monitoring during cardiac surgery with cardiopulmonary bypass (CPB) is unreliable due to physiological changes like non-pulsatile flow and hypothermia, making current autonomic, vascular, pupillary, and EEG-based methods difficult to interpret.

AI-generated from the title and abstract; the full text is not read.

Key points

  • Cardiac surgery with cardiopulmonary bypass (CPB) causes profound physiological alterations that complicate nociception monitoring.
  • Current monitoring technologies (autonomic, vascular, pupillary, EEG) are difficult to interpret during CPB.
  • Existing modalities lack specific validation for cardiac surgery under CPB conditions.
  • Future research needs to focus on cardiac-specific validation and context-aware analytical approaches for nociception monitoring.

AI-generated from the title and abstract; the full text is not read.

Abstract

Abstract Adequate suppression of nociception remains a fundamental objective of modern cardiac anaesthesia. Interpretation of nociception monitoring during cardiac surgery involving cardiopulmonary bypass (CPB), however, is complicated by profound physiological alterations including non-pulsatile circulation, cardioplegic arrest, temperature modulation, vasoactive and inotropic support, pacing, haemodilution, and systemic inflammatory responses. Current monitoring technologies rely on surrogate autonomic, vascular, pupillary, and electroencephalography-derived signals, many of which become difficult to interpret during CPB. Although several modalities demonstrate responsiveness to surgical stimulation under relatively stable perioperative conditions, cardiac-specific validation remains limited and extrapolation of available evidence into CPB conditions remains uncertain. This article discusses the principal physiological limitations affecting intraoperative nociception monitoring during adult cardiac surgery and highlights priorities for future cardiac-specific validation and context-aware analytical approaches.

The authors' abstract, as published at the source. Journal of Clinical Monitoring and Computing, 2026 · DOI ↗

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Field: Neurology (Medicine)

NeurologyMedicine