Comparison of three stimulation sites on the pupillary dilation reflex amplitude evoked by a standardized noxious test

Roquet, Florian; Guezouli, Laila; Wachowska, B.; Balcan, I.; Montravers, Philippe; Longrois, Dan; Guglielminotti, Jean

doi:10.1016/j.accpm.2017.06.007

Cited by 4 publications

(1 citation statement)

References 22 publications

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“…Most of these indexes (ANI, SPI, pupil, NOL) were compared to the classically used clinical parameters of heart rate and blood pressure. [44][45][46][47][48][58][59][60][61][62][63][64][65] Literature indicates that these indexes are more precise to detect intraoperative nociception under general anesthesia. 66 One even more recent study using secondary analysis of 1 study published in 2021 67 demonstrated that some index (here the NOL index) was also able to identify the analgesic effect of intraoperatively administered opioids more precisely than heart rate and blood pressure which suggests it allows for better administration of the opioids during surgery.…”

Section: Middle Latency Evoked Auditory Potentialsmentioning

confidence: 99%

Depth of Anesthesia and Nociception Monitoring: Current State and Vision For 2050

Laferrière-Langlois,

Morisson,

Jeffries

et al. 2024

Anesthesia &Amp; Analgesia

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Anesthesia objectives have evolved into combining hypnosis, amnesia, analgesia, paralysis, and suppression of the sympathetic autonomic nervous system. Technological improvements have led to new monitoring strategies, aimed at translating a qualitative physiological state into quantitative metrics, but the optimal strategies for depth of anesthesia (DoA) and analgesia monitoring continue to stimulate debate. Historically, DoA monitoring used patient’s movement as a surrogate of awareness. Pharmacokinetic models and metrics, including minimum alveolar concentration for inhaled anesthetics and target-controlled infusion models for intravenous anesthesia, provided further insights to clinicians, but electroencephalography and its derivatives (processed EEG; pEEG) offer the potential for personalization of anesthesia care. Current studies appear to affirm that pEEG monitoring decreases the quantity of anesthetics administered, diminishes postanesthesia care unit duration, and may reduce the occurrence of postoperative delirium (notwithstanding the difficulties of defining this condition). Major trials are underway to further elucidate the impact on postoperative cognitive dysfunction. In this manuscript, we discuss the Bispectral (BIS) index, Narcotrend monitor, Patient State Index, entropy-based monitoring, and Neurosense monitor, as well as middle latency evoked auditory potential, before exploring how these technologies could evolve in the upcoming years. In contrast to developments in pEEG monitors, nociception monitors remain by comparison underdeveloped and underutilized. Just as with anesthetic agents, excessive analgesia can lead to harmful side effects, whereas inadequate analgesia is associated with increased stress response, poorer hemodynamic conditions and coagulation, metabolic, and immune system dysregulation. Broadly, 3 distinct monitoring strategies have emerged: motor reflex, central nervous system, and autonomic nervous system monitoring. Generally, nociceptive monitors outperform basic clinical vital sign monitoring in reducing perioperative opioid use. This manuscript describes pupillometry, surgical pleth index, analgesia nociception index, and nociception level index, and suggest how future developments could impact their use. The final section of this review explores the profound implications of future monitoring technologies on anesthesiology practice and envisages 3 transformative scenarios: helping in creation of an optimal analgesic drug, the advent of bidirectional neuron-microelectronic interfaces, and the synergistic combination of hypnosis and virtual reality.

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Section: Middle Latency Evoked Auditory Potentialsmentioning

confidence: 99%

Depth of Anesthesia and Nociception Monitoring: Current State and Vision For 2050

Laferrière-Langlois,

Morisson,

Jeffries

et al. 2024

Anesthesia &Amp; Analgesia

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Effect of Different Concentrations of Propofol Used as a Sole Anesthetic on Pupillary Diameter: A Randomized Trial

Sabourdin

Meniolle

Chemam

et al. 2019

Anesthesia &Amp; Analgesia

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BACKGROUND: Pupillometry monitoring under general anesthesia is based on the assumption that pupillary diameter variations reflect the adequacy of the provided analgesia to the intensity of the nociceptive surgical stimulus. The accurate interpretation of pupillometric data requires establishing clearly what the expected baseline unstimulated pupillary diameter at each specific level of hypnosis is. Opioids decrease pupillary diameter in a dose-dependent fashion. In contrast, the effects of hypnotic drugs on pupillary diameter are not well known. Our aim was to describe the potential relationship between propofol predicted effect-site concentrations (Cets) ranging from 1 to 3 µg/mL and pupillary diameter. METHODS: Patients were randomized to receive propofol by target-controlled infusion at a predicted Cet of 1, 2, or 3 µg/mL (groups P1, P2, and P3, respectively). Pupillary diameter measurements were performed after 10 minutes of steady-state propofol infusion at the randomized Cet. No stimulation was performed during the study. Heart rate and bispectral index (BIS) were continuously recorded. RESULTS: Forty patients were included: (13, 14, and 13 in groups P1, P2, and P3, respectively). Mean pupillary diameter was 5.7 mm (1 mm) in group P1, 4.8 mm (1.3 mm) in group P2, and 3.3 mm (0.8 mm) in group P3. Propofol had a dose-dependent effect on pupillary diameter (linear regression R 2 = 0.45, P < .001). Pupillary diameter was positively correlated with the BIS (Spearman r = 0.75 [95% confidence interval (CI), 0.54 to −0.87] P < .001). CONCLUSIONS: From 1 to 3 µg/mL of predicted Cet, propofol has a dose-dependent effect on pupillary diameter. Within this concentrations range, there is a positive correlation between BIS and pupillary diameter. The subcortical effect of propofol on pupillary diameter is correlated to its effect on the cortex. Studies assessing pupillary diameter as a marker of the nociception–antinociception balance should be performed in patients with a standardized depth of hypnosis.

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Role of automated pupillometry in critically ill patients

2019

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Comparison of three stimulation sites on the pupillary dilation reflex amplitude evoked by a standardized noxious test

Cited by 4 publications

References 22 publications

Depth of Anesthesia and Nociception Monitoring: Current State and Vision For 2050

Depth of Anesthesia and Nociception Monitoring: Current State and Vision For 2050

Effect of Different Concentrations of Propofol Used as a Sole Anesthetic on Pupillary Diameter: A Randomized Trial

Role of automated pupillometry in critically ill patients

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