Department of Anesthesia, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, RH 2835, 705 Riley Hospital Drive, Indianapolis, IN, 46202, USA.
Can J Anaesth. 2021 Apr;68(4):566-578. doi: 10.1007/s12630-020-01905-z. Epub 2021 Jan 11.
Pupillometry is a technique for objective quantification of nociception that takes into account the central processing of noxious stimuli and its sympathetic response. This narrative review provides an overview of the physiology of the pupil, the principles of pupillometry, and its potential application in the perioperative environment, especially in nociception monitoring and quantifying responses to opioids.
Relevant articles, including reports of original investigation, review articles, and meta-analyses were identified from searches of PubMed and Google Scholar databases. Articles that described pupillary physiology and pupillometry, along with original research reports of the application of pupillometry in perioperative and critical care environment were used to synthesize a narrative review.
Pupillometry is emerging as an objective measure of nociception, especially in patients under general anesthesia, children, non-verbal patients, and critically ill patients who cannot effectively communicate ongoing pain. Portable automated pupillometers have made accurate quantification of pupillary reflexes, including light reflex and dilatation reflex, possible. This technique has been successfully studied in the perioperative setting for a number of applications, including quantification of nociception, response to analgesia, and assessing efficacy of regional blocks. Pupillary oscillations have shown promise in assessing central opioid effects. Pupillometers can also accurately quantify light reflexes during the neurologic evaluation of critically ill patients.
Pupillometry is an easy to use non-invasive bedside technique to quantify nociception and monitor opioid effects. It has the potential to personalize pain management in perioperative and intensive care unit environments. Additional studies are needed to further understand the utility of pupillometry in this context.
瞳孔测量是一种客观量化伤害感受的技术,它考虑了有害刺激的中枢处理及其交感反应。本叙述性综述概述了瞳孔的生理学、瞳孔测量的原理及其在围手术期环境中的潜在应用,特别是在伤害感受监测和量化阿片类药物反应方面。
从 PubMed 和 Google Scholar 数据库中搜索到相关文章,包括原始研究报告、综述文章和荟萃分析。本文使用了描述瞳孔生理学和瞳孔测量的文章,以及在围手术期和重症监护环境中应用瞳孔测量的原始研究报告,综合成一篇叙述性综述。
瞳孔测量术作为一种伤害感受的客观测量方法正在兴起,特别是在全身麻醉下的患者、儿童、无法有效表达持续疼痛的非语言患者和重症患者中。便携式自动瞳孔计使瞳孔反射(包括光反射和扩张反射)的精确量化成为可能。该技术已在围手术期成功研究了许多应用,包括伤害感受的量化、对镇痛的反应以及评估区域阻滞的效果。瞳孔波动在评估中枢阿片类药物的作用方面显示出了希望。瞳孔计还可以准确地量化重症患者神经评估期间的光反射。
瞳孔测量术是一种易于使用的非侵入性床边技术,可用于量化伤害感受和监测阿片类药物的作用。它有可能在围手术期和重症监护病房环境中实现疼痛管理的个体化。需要进一步的研究来进一步了解瞳孔测量术在这种情况下的效用。