Department of Anesthesiology and Pain Medicine, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, Korea.
Department of Anesthesiology and Pain Medicine, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, Daegu, Catholic University, Daegu, Korea.
Korean J Anesthesiol. 2023 Apr;76(2):116-127. doi: 10.4097/kja.22324. Epub 2022 Oct 24.
As a side effect of interscalene brachial plexus block (ISBPB), stellate ganglion block (SGB) causes reductions in pupil size (Horner's syndrome) and cardiac sympathetic nervous activity (CSNA). Reduced CSNA is associated with hemodynamic instability when patients are seated. Therefore, instantaneous measurements of CSNA are important in seated patients presenting with Horner's syndrome. However, there are no effective tools to measure real-time CSNA intraoperatively. To evaluate the usefulness of pupillometry in measuring CSNA, we investigated the relationship between pupil size and CSNA.
Forty-two patients undergoing right arthroscopic shoulder surgery under ISBPB were analyzed. Pupil diameters were measured at 30 Hz for 2 s using a portable pupillometer. Bilateral pupil diameters and CSNA (natural-log-transformed low-frequency power [0.04-0.15 Hz] of heart rate variability [lnLF]) were measured before ISBPB (pre-ISBPB) and 15 min after transition to the sitting position following ISBPB (post-sitting). Changes in the pupil diameter ([right pupil diameter for post-sitting - left pupil diameter for post-sitting] - [right pupil diameter for pre-ISBPB - left pupil diameter for pre-ISBPB]) and CSNA (lnLF for post-sitting - lnLF for pre-ISBPB) were calculated.
Forty-one patients (97.6%) developed Horner's syndrome. Right pupil diameter and lnLF significantly decreased upon transition to sitting after ISBPB. In the linear regression model (R2 =0.242, P=0.001), a one-unit decrease (1 mm) in the extent of changes in the pupil diameter reduced the extent of changes in lnLF by 0.659 ln(ms2/Hz) (95% CI [0.090, 1.228]).
Pupillometry is a useful tool to measure changes in CSNA after the transition to sitting following ISBPB.
肌间沟臂丛神经阻滞（ISBPB）的副作用之一是星状神经节阻滞（SGB）导致瞳孔缩小（霍纳综合征）和心脏交感神经活性（CSNA）降低。当患者处于坐姿时，CSNA 减少与血流动力学不稳定有关。因此，对于出现霍纳综合征的坐姿患者，即时测量 CSNA 非常重要。然而，目前还没有有效的工具可以在术中实时测量 CSNA。为了评估瞳孔测量法在测量 CSNA 中的有用性，我们研究了瞳孔大小与 CSNA 之间的关系。
分析了 42 例接受 ISBPB 下右肩关节镜手术的患者。使用便携式瞳孔计以 30 Hz 的频率测量 2 秒的瞳孔直径。在 ISBPB 之前（ISBPB 前）和 ISBPB 后过渡到坐姿后 15 分钟（坐姿后）测量双侧瞳孔直径和 CSNA（心率变异性的自然对数变换低频功率[0.04-0.15 Hz] [lnLF]）。计算瞳孔直径的变化量（[坐姿后右侧瞳孔直径-坐姿后左侧瞳孔直径]-[ISBPB 前右侧瞳孔直径-ISBPB 前左侧瞳孔直径]）和 CSNA（坐姿后 lnLF-ISBPB 前 lnLF）。
41 例患者（97.6%）出现霍纳综合征。ISBPB 后过渡到坐姿时，右侧瞳孔直径和 lnLF 显著下降。在线性回归模型中（R2=0.242，P=0.001），瞳孔直径变化幅度每减少 1 个单位（1 毫米），lnLF 的变化幅度减少 0.659 ln（ms2/Hz）（95%CI[0.090，1.228]）。
瞳孔测量法是一种在 ISBPB 后过渡到坐姿时测量 CSNA 变化的有用工具。
