of pupillary reflex dilation during general anesthesia. J Appl Physiol 97: 725-730, 2004; 10.1152/ japplphysiol.00098.2004.-Areas of insensibility produced by neuraxial anesthesia or peripheral nerve blocks can be detected during general anesthesia by failure of noxious stimulation to trigger pupillary reflex dilation. We examined the latency of pupillary reflex dilation and the effect of fentanyl on the latency of reflex dilation during anesthesia in nine volunteers. We hypothesized that the reflex was generated by slowly conducting C nociceptive fibers and would be significantly delayed if a distal dermatome (L 4) was stimulated compared with a proximal dermatome (C5). We also hypothesized that fentanyl would prolong the latency and alter the shape of the reflex. After induction of general anesthesia, pupillary reflex dilation was measured with an infrared pupillometer every 5 min after stimulations of the L 4 and C5 dermatomes. Fentanyl (3 g/kg) was then given intravenously. Pupillary reflex dilation latencies were calculated by examining each individual measurement. After 3 h, naloxone (400 g) was given intravenously; anesthesia was then discontinued. Pupillary reflex dilation had a long latency and consisted of distinct early and late phases. No differences were found between latencies of reflex dilation after simulation of L 4 and C5 dermatomes either before or after fentanyl administration. Fentanyl at high concentrations essentially eliminated pupillary reflex dilation; but over the 180-min observation period, first early and then late dilation returned. Fentanyl produced a small increase in the latency of the initial early dilation. We conclude that pupillary reflex dilation during anesthesia is not initiated by slowly conducting C fibers and that fentanyl depresses the reflex in a stereotypical manner. nociception; windup; pupil; opioids; sensory block PUPILLARY REFLEX DILATION (PRD) is a midbrain reflex that has been used clinically to define the extent of local anesthetic blockade during general anesthesia. Although the reflex peaks 1 min after the stimulus starts, a more prompt assessment of sensory blockade should be possible by examining the early portion of the reflex. Thus knowledge of the latency of PRD, and the factors that influence latency, is critical for a timely and reliable detection of the reflex, especially when the reflex magnitude has been attenuated by anesthetic adjuvants including opioids (14,19).Studies in anesthetized animals have shown that the reflex latency is ϳ350 ms (2, 23). The feline reflex proceeds from the nociceptor primarily via C-fiber transmission (8) to the spinal cord and then to the midbrain where norepinephrine-containing neurons are activated. These neurons then inhibit the pupilloconstrictor neurons, resulting in a passive dilation of the pupil (11).Although the reflex in anesthetized humans is thought to be similarly expressed (13, 28), preliminary evidence has shown that the latency of PRD in anesthetized humans is remarkably long and proceeds in two distin...
We conclude that during general anaesthesia, epidural fentanyl enhances antinociception by a spinal mechanism which can be detected by pupillary dilation but not by changes in arterial pressure or heart rate.
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