Stefanini Martino, Cagnazzi Elena, Calza Stefano, Latronico Nicola, Rasulo Francesco A
Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25123, Brescia, Italy.
Department of Anesthesia, Intensive Care and Emergency, ASST Spedali Civili University Hospital, Piazzale Spedali Civili, 1, 25123, Brescia, Italy.
J Anesth Analg Crit Care. 2023 Aug 14;3(1):27. doi: 10.1186/s44158-023-00112-8.
The pupillary dilation reflex (PDR) is an objective indicator of analgesic levels in anesthetized patients. Through measurement of the PDR during increasing tetanic stimulation (10-60 mA), it is possible to obtain the pupillary pain index (PPI), a score that assesses the level of analgesia.
The depth of analgesia during opioid-sparing anesthesia (OSA) with continuous infusion of dexmedetomidine in addition to general anesthesia was assessed.
Observational prospective feasibility pilot study SETTING: This study was performed in the operating rooms of the Spedali Civili University-affiliated hospital of Brescia, Italy.
Forty-five adults who underwent elective open (5-cm incision) surgery under general anesthesia (78% inhalation anesthesia), from Feb. 18th to Aug. 1st, 2019, were enrolled. Exclusion criteria were as follows: implanted pacemaker or ICD, ophthalmological comorbidities, chronic opioid use, peripheral neuropathy, other adjuvant drugs, epidural analgesia, or locoregional block.
The first aim was to verify the feasibility of applying a study protocol to evaluate the depth of analgesia during intraoperative dexmedetomidine administration using an instrumental pupillary evaluation. The secondary outcome was to evaluate appropriate analgesia, drug dosage, anesthesia depth, heart rate, blood pressure, transient side effects, postoperative nausea and vomiting (PONV), and pain numerical rating scale (NRS) score.
Thirty out of 50 patients (60%) treated with dexmedetomidine during the study period were included in the DEX group (8 males, age 42 ± 13 years, BMI 45 ± 8), and 15 other patients were included in the N-DEX group (8 males, age 62 ± 13 years, BMI 26 ± 6). Patients who underwent bariatric, abdominal, or plastic surgery were enrolled. At least 3 pupillary evaluations were taken for each patient. PPI ≤ 3 was observed in 97% of patients in the DEX group and 53% in the N-DEX group. Additionally, the DEX group received less than half the remifentanil dose than the N-DEX group (0.13 ± 0.07 vs 0.3 ± 0.11 mcg kg min). The average dose of dexmedetomidine administered was 0.17 ± 0.08 mcg kg h.
The feasibility of applying the protocol was verified. An OSA strategy involving dexmedetomidine may be associated with improved analgesic stability: a randomized controlled trial is necessary to verify this hypothesis.
Trial.gov registration number: NCT05785273.
瞳孔散大反射（PDR）是麻醉患者镇痛水平的客观指标。通过在递增强直刺激（10 - 60 mA）期间测量PDR，可获得瞳孔疼痛指数（PPI），这是一个评估镇痛水平的分数。
评估在全身麻醉基础上持续输注右美托咪定的保留阿片类药物麻醉（OSA）期间的镇痛深度。
观察性前瞻性可行性初步研究
本研究在意大利布雷西亚市斯皮德ali Civili大学附属医院的手术室进行。
纳入了2019年2月18日至8月1日期间在全身麻醉（78%吸入麻醉）下接受择期开放（5厘米切口）手术的45名成年人。排除标准如下：植入起搏器或植入式心脏除颤器（ICD）、眼科合并症、长期使用阿片类药物、周围神经病变、其他辅助药物、硬膜外镇痛或局部区域阻滞。
首要目的是验证应用研究方案通过仪器瞳孔评估来评估术中输注右美托咪定期间镇痛深度的可行性。次要结果是评估适当的镇痛效果、药物剂量、麻醉深度、心率、血压、短暂副作用、术后恶心呕吐（PONV）以及疼痛数字评分量表（NRS）评分。
研究期间接受右美托咪定治疗的50名患者中有30名（60%）被纳入DEX组（8名男性，年龄42±13岁，体重指数45±8），另外15名患者被纳入N - DEX组（8名男性，年龄62±13岁，体重指数26±6）。纳入了接受减肥手术、腹部手术或整形手术的患者。每位患者至少进行3次瞳孔评估。DEX组97%的患者和N - DEX组53%的患者观察到PPI≤3。此外，DEX组接受的瑞芬太尼剂量不到N - DEX组的一半（0.13±0.07 vs 0.3±0.11 mcg·kg - 1·min - 1）。右美托咪定的平均给药剂量为0.17±0.08 mcg·kg - 1·h - 1。
验证了应用该方案的可行性。涉及右美托咪定的OSA策略可能与改善镇痛稳定性相关：需要进行一项随机对照试验来验证这一假设。
Trial.gov注册号：NCT05785273。
