Prediction of Opioid Analgesic Efficacy by Measurement of Pupillary Unrest

Neice, Andrew; Behrends, Matthias; Bokoch, Michael P.; Seligman, K.M.; Conrad, Nicole M; Larson, Merlín D.

doi:10.1213/ane.0000000000001728

Cited by 42 publications

(30 citation statements)

References 23 publications

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“…Perhaps, some neuronal (or neurochemical) modulation exists in psychedelic (ab)users. Contrary to psychedelic users, users and misusers of opium and opioid substances experience a constricted (miotic) pupil, or even a pinpoint pupillary aperture [ 37 ]. Heroin, fentanyl, codeine, methadone, and morphine act via stimulation of the PNS [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Could Hallucinogens Induce Permanent Pupillary Changes in (Ab)users? A Case Report from New Zealand

Al-Imam

2017

Case Reports in Neurological Medicine

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An eighteen-year-old female patient of the Caucasian ethnicity from Australasia presented with a persistently dilated pupil causing her discomfort and occasional burning sensation when she is outdoors due to oversensitivity to sunlight. However, her pupillary reaction to light (pupillary light reflex) was intact. The patient is a known user of psychedelic substances (entheogens) including LSD, NBOMe, psilocybin, and DMT. The condition affects both eyes to the same extent. Thorough medical, neurological, and radiological examinations, including an EEG and an MRI of the head and neck region, were completely normal. All these tests failed to detect any pathophysiological or anatomical abnormalities. The patient is a known case of chronic endogenous depression in association with attention deficit hyperactivity disorder, for which she is taking citalopram and Ritalin, respectively. There was neither a family history nor a similar congenital condition in her family.

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Section: Discussionmentioning

confidence: 99%

Could Hallucinogens Induce Permanent Pupillary Changes in (Ab)users? A Case Report from New Zealand

Al-Imam

2017

Case Reports in Neurological Medicine

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“…Although current research addressing this complex issue provides some promising innovative techniques, no standardized objective pain monitoring protocols exist 2. Furthermore, there is a need for consensus to use and interpret different pupil assessment features, such as light‐induced PDR,15, 26 nociceptive stimulation‐induced PDR,8, 27 pupillary unrest,28 constriction velocity and reaction latency29 or PPI score 5…”

Section: Discussionmentioning

confidence: 99%

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

Wildemeersch

Peeters

Saldien

et al. 2018

Acta Anaesthesiol Scand

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BackgroundIn response to noxious stimulation, pupillary dilation reflex (PDR) occurs even in anaesthetized patients. The aim of the study was to evaluate the ability of pupillometry with an automated increasing stimulus intensity to monitor intraoperative opioid administration.MethodsThirty‐four patients undergoing elective surgery were enrolled. Induction by propofol anaesthesia was increased progressively until the sedation depth criteria (SeD) were attained. Subsequently, a first dynamic pupil measurement was performed by applying standardized nociceptive stimulation (SNS). A second PDR evaluation was performed when remifentanil reached a target effect‐site concentration. Automated infrared pupillometry was used to determine PDR during nociceptive stimulations generating a unique pupillary pain index (PPI). Vital signs were measured.ResultsAfter opioid administration, anaesthetized patients required a higher stimulation intensity (57.43 mA vs 32.29 mA, P < .0005). Pupil variation in response to the nociceptive stimulations was significantly reduced after opioid administration (8 mm vs 28 mm, P < .0005). The PPI score decreased after analgesic treatment (8 vs 2, P < .0005), corresponding to a 30% decrease. The elicitation of PDR by nociceptive stimulation was performed without changes in vital signs before (HR 76 vs 74/min, P = .09; SBP 123 vs 113 mm Hg, P = .001) and after opioid administration (HR 63 vs 62/min, P = .4; SBP 98.66 vs 93.77 mm Hg, P = .032).ConclusionsDuring propofol anaesthesia, pupillometry with the possibility of low‐intensity standardized noxious stimulation via PPI protocol can be used for PDR assessment in response to remifentanil administration.

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“…We have just touched the surface here by demonstrating the usefulness of a dual wavelength light source in dissecting out physiological spectral sensitivity in a mouse model. In addition, there is a range of clinical uses for such a system spanning from neurosurgery, psychiatry, and ophthalmology through to sleep medicine [9,10,13]. There is a wide spectrum of uses/ application for the SCWL and we believe this to be of great benefit to the advancement of science and healthcare.…”

Section: Discussionmentioning

confidence: 99%

“…Through manipulation of the light source, for both intensity and wavelength, it is possible to assess/ allude to the contribution of each receptor class to the PLR [1]. Clinically, the PLR has shown promise in the assessment of brainstem function and in the management of pain, through the impact of pupil sensitivity to opioids [9,10]. Traditionally, the PLR setup has utilised a powerful xenon arc light source with wavelength and intensity all regulated by chromatic/ neutral density filters [4].…”

Section: Introductionmentioning

confidence: 99%

Use of a supercontinuum white light in evaluating the spectral sensitivity of the pupil light reflex

Chin

Leick

Podoleanu

et al. 2018

2nd Canterbury Conference on OCT With Emphasis on Broadband Optical Sources

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We assessed the spectral sensitivity of the pupillary light reflex in mice using a high power super continuum white light (SCWL) source in a dual wavelength configuration. This novel approach was compared to data collected from a more traditional setup using a Xenon arc lamp fitted with monochromatic interference filters. Irradiance response curves were constructed using both systems, with the added benefit of a two-wavelength, equivalent power, output using the SCWL. The variables applied to the light source were intensity, wavelength and stimulus duration through which the physiological output measured was the minimum pupil size attained under such conditions. We show that by implementing the SCWL as our novel stimulus we were able to dramatically increase the physiological usefulness of our pupillometry system.

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Prediction of Opioid Analgesic Efficacy by Measurement of Pupillary Unrest

Cited by 42 publications

References 23 publications

Could Hallucinogens Induce Permanent Pupillary Changes in (Ab)users? A Case Report from New Zealand

Could Hallucinogens Induce Permanent Pupillary Changes in (Ab)users? A Case Report from New Zealand

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

Use of a supercontinuum white light in evaluating the spectral sensitivity of the pupil light reflex

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