Wildemeersch D, Peeters N, Saldien V, Vercauteren M, Hans G
Department of Anaesthesia, Antwerp University Hospital (UZA), Edegem, Belgium.
Multidisciplinary Pain Centre, Antwerp University Hospital (UZA), Edegem, Belgium.
Acta Anaesthesiol Scand. 2018 Sep;62(8):1050-1056. doi: 10.1111/aas.13129. Epub 2018 Apr 19.
In response to noxious stimulation, pupillary dilation reflex (PDR) occurs even in anaesthetized patients. The aim of the study was to evaluate the ability of pupillometry with an automated increasing stimulus intensity to monitor intraoperative opioid administration.
Thirty-four patients undergoing elective surgery were enrolled. Induction by propofol anaesthesia was increased progressively until the sedation depth criteria (SeD) were attained. Subsequently, a first dynamic pupil measurement was performed by applying standardized nociceptive stimulation (SNS). A second PDR evaluation was performed when remifentanil reached a target effect-site concentration. Automated infrared pupillometry was used to determine PDR during nociceptive stimulations generating a unique pupillary pain index (PPI). Vital signs were measured.
After opioid administration, anaesthetized patients required a higher stimulation intensity (57.43 mA vs 32.29 mA, P < .0005). Pupil variation in response to the nociceptive stimulations was significantly reduced after opioid administration (8 mm vs 28 mm, P < .0005). The PPI score decreased after analgesic treatment (8 vs 2, P < .0005), corresponding to a 30% decrease. The elicitation of PDR by nociceptive stimulation was performed without changes in vital signs before (HR 76 vs 74/min, P = .09; SBP 123 vs 113 mm Hg, P = .001) and after opioid administration (HR 63 vs 62/min, P = .4; SBP 98.66 vs 93.77 mm Hg, P = .032).
During propofol anaesthesia, pupillometry with the possibility of low-intensity standardized noxious stimulation via PPI protocol can be used for PDR assessment in response to remifentanil administration.
在受到伤害性刺激时，即使是麻醉患者也会出现瞳孔扩张反射（PDR）。本研究的目的是评估采用自动增加刺激强度的瞳孔测量法监测术中阿片类药物给药的能力。
纳入34例行择期手术的患者。丙泊酚麻醉诱导逐渐加深，直至达到镇静深度标准（SeD）。随后，通过施加标准化伤害性刺激（SNS）进行首次动态瞳孔测量。当瑞芬太尼达到目标效应室浓度时，进行第二次PDR评估。在伤害性刺激期间，使用自动红外瞳孔测量法确定PDR，生成独特的瞳孔疼痛指数（PPI）。测量生命体征。
给予阿片类药物后，麻醉患者需要更高的刺激强度（57.43 mA对32.29 mA，P <.0005）。给予阿片类药物后，对伤害性刺激的瞳孔变化显著减少（8 mm对28 mm，P <.0005）。镇痛治疗后PPI评分降低（8对2，P <.0005），相当于降低了30%。在给予阿片类药物之前（心率76对74次/分钟，P =.09；收缩压123对113 mmHg，P =.001）和之后（心率63对62次/分钟，P =.4；收缩压98.66对93.77 mmHg，P =.032），伤害性刺激诱发PDR时生命体征无变化。
在丙泊酚麻醉期间，通过PPI方案进行低强度标准化伤害性刺激的瞳孔测量法可用于评估瑞芬太尼给药后的PDR。
