The Nociception Level (NOL) Index for Pain Assessment in the Adult Intensive Care Unit

The NOL integrates multiple physiologic parameters that are captured through a finger probe with disposable sensor. These parameters include heart rate, heart rate variability, photoplethysmography pulse wave amplitude, skin conductance and temperature, and their time derivatives. All these parameters are analyzed simultaneously to provide the NOL index which can range from 0 to 100. Values \>25 were found to be indicative of nociception and related-pain in the field of anesthesia. The investigators will use the Pain Monitoring Device-200 (PMD-200)TM, which offers the multi-parametric NOL index (0-100) (Medasense Biometrics Ltd., Ramat Gan, Israel), and was approved by Health Canada for clinical use in September 2017.