Operating Rooms, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, Fukuoka, Japan.
J Anesth. 2019 Oct;33(5):594-599. doi: 10.1007/s00540-019-02672-y. Epub 2019 Aug 17.
Arterial hypotension is a major adverse effect of general anesthesia. Patients with pre-existing autonomic dysfunction are at greater risk of hypotension. This study was performed to examine whether objective measurement of the pupillary light reflex is predictive of intraoperative hypotension.
We studied 79 patients who underwent scheduled surgery under general anesthesia. Patients with severe cardiovascular disease or receiving antihypertensive agents were excluded. The light reflex was measured preoperatively using a portable infrared pupillometer, and the hemodynamic parameters were obtained from the anesthesia records. The patients were divided into two groups according to the development of hypotension: the hypotension and normotension groups. Multivariate logistic regression analysis was performed to determine the pupil parameters predictive of hypotension.
Patients in the hypotension group were older and had a greater pupil size or constriction velocity than those in the normotension group. Logistic regression analysis showed that post-induction hypotension was significantly associated with maximum pupil size or constriction velocity after adjustment for age and other clinical variables. Latency of the light reflex and the percent reduction of pupil size were not associated with hypotension. Age was a relatively strong predictor of hypotension; other confounding factors were not associated with hypotension.
Measurement of maximum pupil size is useful to identify patients at risk for intraoperative hypotension. The influence of age must be considered during measurement of the pupil response.
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低血压是全身麻醉的主要不良反应。存在自主神经功能障碍的患者发生低血压的风险更高。本研究旨在探讨瞳孔对光反射的客观测量是否可预测术中低血压。
我们研究了 79 例在全身麻醉下接受择期手术的患者。排除严重心血管疾病或正在服用降压药物的患者。使用便携式红外瞳孔计在术前测量光反射，从麻醉记录中获取血流动力学参数。根据低血压的发生情况将患者分为低血压组和正常血压组。采用多变量逻辑回归分析确定预测低血压的瞳孔参数。
低血压组患者年龄较大，瞳孔大小或收缩速度大于正常血压组。逻辑回归分析显示，在调整年龄和其他临床变量后，诱导后低血压与最大瞳孔大小或收缩速度显著相关。光反射潜伏期和瞳孔缩小百分比与低血压无关。年龄是低血压的一个相对较强的预测因素；其他混杂因素与低血压无关。
测量最大瞳孔大小有助于识别术中发生低血压的风险患者。在测量瞳孔反应时必须考虑年龄的影响。
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