Shirozu Kazuhiro, Setoguchi Hidekazu, Tokuda Kentaro, Karashima Yuji, Ikeda Mizuko, Kubo Makoto, Nakamura Katsuya, Hoka Sumio
Operating Rooms, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
Intensive Care Unit, Kyushu University Hospital, Fukuoka, Japan.
J Clin Monit Comput. 2017 Apr;31(2):291-296. doi: 10.1007/s10877-016-9839-3. Epub 2016 Feb 8.
Pupil reactivity can be used to evaluate central nervous system function and can be measured using a quantitative pupillometer. However, whether anesthetic agents affect the accuracy of the technique remains unclear. We examined the effects of anesthetic agents on pupillary reactivity. Thirty-five patients scheduled for breast or thyroid surgery were enrolled in the study. Patients were divided into four groups based on the technique used to maintain anesthesia: a sevoflurane-remifentanil (SEV/REM) group, a sevoflurane (SEV) group, a desflurane-remifentanil (DES/REM) group, and a propofol-remifentanil (PRO/REM) group. We measured maximum resting pupil size (MAX), reduction pupil size ratio (%CH), latency duration (LAT) and neurological pupil index (NPi). A marked reduction in MAX and %CH compared with baseline was observed in all groups, but LAT was unchanged during surgery. NPi reduced within the first hour of surgery in the SEV/REM, SEV, and DES/REM groups, but was not significantly different in the PRO/REM group. Compared with the PRO/REM group, mean %CH and NPi in patients anesthetized with SEV/REM, SEV or DES/REM were markedly lower at 1 h after surgery had commenced. There was no correlation between NPi and bispectral index. Fentanyl given alone decreased pupil size and %CH in light reflex, but did not change the NPi. NPi was decreased by inhalational anesthesia not but intravenous anesthesia. The difference in pupil reactivity between inhalational anesthetic and propofol may indicate differences in the alteration of midbrain reflexs in patients under inhalational or intravenous anesthesia.
瞳孔反应性可用于评估中枢神经系统功能，并且可以使用定量瞳孔计进行测量。然而，麻醉剂是否会影响该技术的准确性仍不清楚。我们研究了麻醉剂对瞳孔反应性的影响。35例计划进行乳房或甲状腺手术的患者纳入本研究。根据维持麻醉所用技术将患者分为四组：七氟醚-瑞芬太尼（SEV/REM）组、七氟醚（SEV）组、地氟醚-瑞芬太尼（DES/REM）组和丙泊酚-瑞芬太尼（PRO/REM）组。我们测量了最大静息瞳孔大小（MAX）、瞳孔缩小比例（%CH）、潜伏期（LAT）和神经瞳孔指数（NPi）。所有组均观察到与基线相比MAX和%CH显著降低，但手术期间LAT未改变。SEV/REM、SEV和DES/REM组在手术的第一小时内NPi降低，但PRO/REM组无显著差异。与PRO/REM组相比，在手术开始后1小时，接受SEV/REM、SEV或DES/REM麻醉的患者的平均%CH和NPi明显更低。NPi与脑电双频指数之间无相关性。单独给予芬太尼可使瞳孔大小和光反射中的%CH降低，但不改变NPi。吸入麻醉可降低NPi，而静脉麻醉则不然。吸入麻醉剂与丙泊酚之间瞳孔反应性的差异可能表明吸入或静脉麻醉患者中脑反射改变的差异。
