medigraphic.com
Órgano Oficial del Hospital Angeles Health System

2016, Number 2

<< Back Next >>

Acta Med 2016; 14 (2)

Infrared pupillometry for monitoring transoperative analgesia in patients under general anesthesia

Rivera GA, Sánchez VJ

Language: Spanish
References: 16
Page: 69-76
PDF size: 233.85 Kb.


ABSTRACT

Our aim is to establish if infrared pupillometry is useful to measure the analgesia level in patients under general anesthesia and to correlate the pupillometry values with the vital signs, the BIS and the opioid plasma concentration when the nociceptive stimulus is presented. Research: pilot, descriptive, prospective, with a non-probabilistic sample and consecutive assignation. A group of 20 women with breast cancer was recruited. All of them were scheduled for a radical mastectomy and an axillary dissection. Their vital signs and BIS were monitored. Balanced general anesthesia was applied with desflurane, and sufentanil and lidocaine infusions. We worked with the video pupillometer Neurolight Algiscan (Idimed). The first measurement was performed a minute after the first incision, and the second, at the axillary dissection. In both, the vital signs and the BIS values were recorded and the opioid concentration was calculated. Results were analyzed with a simple linear regression (Excel 2010). Conclusion: The quantitative value measured by the pupillometry agrees with the opioid plasma concentration; statistically, it is not correlated with the vital signs or BIS. Infrared pupillometry was useful to measure the intraoperative analgesia level in patients under general anesthesia. It is the first research of this kind in Mexico.


REFERENCES

  1. Larson M, Tayefeh F, Sessler D, Malcom D et al. Sympathetic nervous system does not mediate reflex pupillary dilation during desflurane anesthesia. Anesthesiology. 1996; 85 (4): 748-754.

  2. Yang L, Niemann C, Larson MD. Mechanism of pupillary reflex dilation in awake volunteers and in organ donors. Anesthesiology. 2003; 99 (6): 1281-1286.

  3. Szabadi E. Modulation of physiological reflexes by pain: role of the locus coeruleus. Front Integr Neurosci. 2012; 6: 94.

  4. León-Sarmiento F, Prada D, Gutiérrez C. Pupila, pupilometría y pupilografía. Acta Neurol Colombia. 2008; 24: 188-197.

  5. Martínez-Ricarte F, Castro A, Poca MA, Sahuquillo J et al. Pupilometría por infrarrojos. Descripción y fundamentos de la técnica y su aplicación en la monitorización no invasiva del paciente neurocrítico. Neurología. 2013; 28 (1): 41-51.

  6. Gluglielminotti J, Grillot N, Paule M, Mentré F et al. Prediction of movement to surgical stimulation by the pupillary dilatation reflex amplitude evoked by a standardized noxious test. Anesthesiology. 2015; 122 (5): 985-993.

  7. Rollins M, Freiner J, Lee J, Shah S, Larson M. Pupillary effects of high-dose opioid quantified with infrared pupillometry. Anesthesiology. 2014; 121 (5): 1037-1044.

  8. Shafer S, Varvel J. Pharmacokinetics, pharmacodynamics and rational opioid selection. Anesthesiology. 1991; 74 (1): 53-63.

  9. Larson M, Sessler D, Ozaki M, McGuire J et al. Pupillary assessment of sensory block level during combined epidural/general anesthesia. Anesthesiology. 1993; 79 (1): 42-48.

  10. Isnardon S, Vinclair M, Genty C, Hebrard A et al. Pupillometry to detect pain response during general anaesthesia following unilateral popliteal sciatic nerve block. A prospective, observational study. Eur J Anaesthesiology. 2013; 30 (7): 429-434.

  11. Mourad A, Snauwaert A, Dupuis C, Atchabahian A. Objective assessment of the immediate postoperative analgesia using pupillary reflex measurement. Anesthesiology. 2012; 116: 1006-1012.

  12. Takamatsu I, Ozaki M, Kazama T. Entropy indices vs the bispectral index for estimating nociception during sevoflurane anaesthesia. Br J Anaesth. 2006; 96 (5): 620-626.

  13. Larson MD, Kurz A, Sessler DI, Dechert M et al. Alfentanil blocks reflex pupillary dilation in response to noxious stimulation but does not diminish the light reflex. Anesthesiology. 1997; 87 (4): 849-855.

  14. Le Guen M, Jeanne M, Sievert K, Al Moubarik M et al. The analgesia Nociception Index: a pilot study to evaluation of a new pain parameter during labor. Int J Obstet Anesth. 2012; 21 (2): 146-151.

  15. Szental JA, Webb A, Weeraratne C, Campbell A et al. Postoperative pain after laparoscopic cholecystectomy is not reduced by intraoperative analgesia guided by analgesia nociception index (ANI®) monitoring: a randomized clinical trial. Br J Anaesth. 2015; 114 (4): 640-645.

  16. Huiku M, Uutela K, van Gils M, Korhonen I et al. Assessment of surgical stress during general anaesthesia. Br J Anaesth. 2007; 98 (4): 447-455.




2020     |     www.medigraphic.com