Pain assessment by pupil dilation reflex in response to noxious stimulation in anaesthetized adults

Wildemeersch, Davina; Peeters, Natasja; Saldien, Vera; Vercauteren, M.; Hans, Guy

doi:10.1111/aas.13129

Cited by 52 publications

(36 citation statements)

References 29 publications

(34 reference statements)

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“…For what concerns the CPS, the scores were given as follow. In response to noxious stimulation, pupillary dilation reflex occurs 20 ; therefore, pupil dilation was included in our composite pain scale and it was scored as present (score 1) or not present (score 0).…”

Section: Methodsmentioning

confidence: 99%

Development and validation of a multidimensional composite pain scale for Rabbit (CANCRS) in a clinical environment

Banchi

Quaranta

Ricci

et al. 2019

Preprint

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The main objective of this study was to develop a multidimensional composite pain scale for assessing and quantifying pain in rabbits (CANCRS); to this purpose, Rabbit Grimace Scale (RbtGS) and a scale including clinical parameters (CPS) were merged; the two scales performances were also evaluated individually, in order to validate RbtGS in a clinical setting and to verify clinical parameters usefulness in detecting pain.Rabbits (n=116) were evaluated by two raters, who could be veterinarians (V) or veterinary medicine students (S). Raters were asked to report the time needed for any evaluation and a total score, in order to define a pain class. Pain classes (No pain, Discomfort, Moderate pain and Severe pain) matched presumptive pain classes and accordingly, the validity of the three scales was measured using Chi-square test.Patients (n=69) were evaluated by one V and one S, allowing to assess the impact that the experience has on the results. Inter-rater reliability was tested for each scale using intra-class correlation coefficient (ICC) and for each parameter of the CANCRS using Cohen’s kappa. Validity results show that only CANCRS and RbtGS efficiently reveal pain, but both tend to underestimate it.Inter-rater reliability was very good for both CANCRS and CPS, suggesting that experience has little influence on the results; rater’s experience has a greater impact using RbtGS.Inter-rater agreement was at least good for each parameter.In conclusion, CPS alone is neither effective or reliable in quantifying pain.The RbtGS is a useful tool in clinical practice, when coping with many rabbit breeds; however, training is beneficial for a better use of the scale.The CANCRS is easy and fast to use and enrich RbtGS with some clinical parameters that should be monitored during any clinical examination, leading to a more exhaustive evaluation of the patient.

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Section: Methodsmentioning

confidence: 99%

Development and validation of a multidimensional composite pain scale for Rabbit (CANCRS) in a clinical environment

Banchi

Quaranta

Ricci

et al. 2019

Preprint

View full text Add to dashboard Cite

show abstract

“…Furthermore, respiratory pattern was included, in order to have a more accurate overview of the respiratory response to pain, since polypnea is not pain specific. Finally, pupil dilation can occur in painful situations [23,24].…”

Section: Pain Scalesmentioning

confidence: 99%

Reliability and construct validity of a composite pain scale for rabbit (CANCRS) in a clinical environment

et al. 2020

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A composite pain scale for assessing and quantifying pain in rabbits (CANCRS) has been designed merging the Rabbit Grimace Scale (RbtGS) and a scale including clinical parameters (CPS). Construct validity and inter-rater reliability were assessed for CANCRS, for RbtGS and for CPS, in order to test their potential to detect pain in a clinical setting. Rabbits (n = 116) were either hybrids or purebreds and they were independently evaluated by two raters, who could be veterinarians (V) or veterinary medicine students (S). Score intervals determined four pain classes (No pain, Discomfort, Moderate pain and Severe pain) that matched presumptive pain classes associated with some pathological conditions. A chisquare test was used to assess the construct validity of the scales by checking how frequently scale results and presumptive pain classes matched. Sixty-nine patients were evaluated by one V and one S, whereas forty-seven rabbits were assessed by two V, in order to test inter-rater reliability. An intra-class correlation coefficient (ICC) was used to test reliability of the scales, whereas Cohen's kappa tested inter-rater agreement for each parameter of the CANCRS. Construct validity results show that CANCRS and RbtGS efficiently reveal pain (P � 0.05), while CPS does not (p > 0.05). Inter-rater reliability was very good for both CANCRS and CPS (ICC 0.88 V-V, 0.94 between V-S; ICC 0.97 V-V, 0.91 V-S) and good for RbtGS (ICC 0.77 V-V, 0.88 V-S); therefore, CPS reproducibility was better between veterinarians and students than between veterinarians. Inter-rater agreement between veterinarians and veterinary medicine students was moderate to very good for all the parameters included in the CANCRS (Cohen's kappa >0,60). In conclusion, it is possible to state that the CANCRS has construct validity and it is a reliable tool for use in clinical practice, when coping with many rabbits with morphological differences. It is easy and fast to use and enriches the RbtGS with some clinical parameters that should be monitored during any clinical examination, allowing for capture of the multidimensional aspect of pain.

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“…The problem lies in the fact that our understanding of the human consciousness state is still incomplete and we still lack information about the exact effects of general anesthesia on the brain. The depth of anesthesia is neither stable, nor constant; it is more of a dynamic action that depends on the balance between the dosage of anesthetic medication and the pain caused by the surgical intervention [18][19][20]. Using EEG signal in order to monitor the depth of general anesthesia should reduce the incidence of intranesthetic awareness and should lead to a reduction in anesthetic medication consumption, as well as reduce the incidence of adverse effects related to anesthesia and lead to shorter recovery times [21,22].…”

Section: Introductionmentioning

confidence: 99%

Multiparametric Monitoring of Hypnosis and Nociception-Antinociception Balance During General Anesthesia - A New Era in Patient Safety Standards and Healthcare Management

Rogobete¹,

Bedreag²,

Păpurică³

et al. 2020

Preprint

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Worldwide, an increasing number of patients undergo complex surgeries. With the development of general anesthesia techniques and anesthetic substances, the most complex surgical techniques could be developed. In order to adapt the anesthesia according to the particularities of each patient, it is recommended the multimodal monitoring of these patients. Classically, general anesthesia monitoring consists of the analysis of vital functions and gas exchange. Multimodal monitoring refers to the concomitant monitoring of the degree of hypnosis and the nociceptive-antinociceptive balance. By titrating anesthetic drugs according to these parameters, clinical benefits can be obtained, such as hemodynamic stabilization, reduction of awakening times, reduction of post-operative complications. Also, there is an important impact on the status of inflammation and the redox balance. The purpose of this literature review is to present the most modern multimodal monitoring techniques, respectively to discuss the particularities of each technique.

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Pain assessment by pupil dilation reflex in response to noxious stimulation in anaesthetized adults

Cited by 52 publications

References 29 publications

Development and validation of a multidimensional composite pain scale for Rabbit (CANCRS) in a clinical environment

Development and validation of a multidimensional composite pain scale for Rabbit (CANCRS) in a clinical environment

Reliability and construct validity of a composite pain scale for rabbit (CANCRS) in a clinical environment

Multiparametric Monitoring of Hypnosis and Nociception-Antinociception Balance During General Anesthesia - A New Era in Patient Safety Standards and Healthcare Management

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