Pharmacodynamic modelling of the effect of remifentanil using the Pupillary Pain Index

Vide, Sérgio; Castro, Ana; Antunes, Paulo; Lima, Deolinda; Larson, Merlín D.; Gambús, Pedro L.; Amorim, Pedro

doi:10.1007/s10877-019-00323-x

Cited by 7 publications

(3 citation statements)

References 17 publications

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“…The use of changes in pupillary parameters as a surrogate marker of analgesic effects has received considerable attention in the past. PRD was shown to be useful to assess the nociception/antinociception balance and titrate opioid administration 30 as PRD is triggered by noxious stimuli during general anesthesia 6 , 7 and diminished by opioid administration. 8 Our results support the observations by Barvais et al 8 for the correlation between remifentanil Ce and percentage PRD as shown in Figure 5 .…”

Section: Discussionmentioning

confidence: 99%

Semimechanistic models to relate noxious stimulation, movement, and pupillary dilation responses in the presence of opioids

Marco-Ariño

Vide

Agustí

et al. 2021

CPT Pharmacom & Syst Pharma

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Intraoperative targeting of the analgesic effect still lacks an optimal solution. Opioids are currently the main drug used to achieve antinociception, and although underdosing can lead to an increased stress response, overdose can also lead to undesirable adverse effects. To better understand how to achieve the optimal analgesic effect of opioids, we studied the influence of remifentanil on the pupillary reflex dilation (PRD) and its relationship with the reflex movement response to a standardized noxious stimulus. The main objective was to generate population pharmacodynamic models relating remifentanil predicted concentrations to movement and to pupillary dilation during general anesthesia. A total of 78 patients undergoing gynecological surgery under general anesthesia were recruited for the study. PRD and movement response to a tetanic stimulus were measured multiple times before and after surgery. We used nonlinear mixed effects modeling to generate a population pharmacodynamic model to describe both the time profiles of PRD and movement responses to noxious stimulation. Our model demonstrated that movement and PRD are equally depressed by remifentanil. Using the developed model, we changed the intensity of stimulation and simulated remifentanil predicted concentrations maximizing the probability of absence of movement response. An estimated effect site concentration of 2 ng/ml of remifentanil was found to inhibit movement to a tetanic stimulation with a probability of 81%.

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Section: Discussionmentioning

confidence: 99%

Semimechanistic models to relate noxious stimulation, movement, and pupillary dilation responses in the presence of opioids

Marco-Ariño

Vide

Agustí

et al. 2021

CPT Pharmacom & Syst Pharma

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show abstract

“…AlgiScan ® , PDR'yi ölçerek, 1-9 arasında bir ölçekte (1: nosisepsiyon yokluğunu ve 9: maksimum nosisepsiyonu gösteren) nosisepsiyon indeksi, Pupil Ağrı İndeksi [Pupillary Pain Index (PPI)] üretir. 41 Anestezi uzmanının intraoperatif olarak hastanın yüzüne serbestçe erişebildiği işlemlerde ve pupiller reaktivitesi bozulmamış hastalarda kullanılmalıdır. Pupil çapının noksius uyaranlarla arttığı, opioid uygulamasıyla azaldığı, propofolün pupil çapı üzerinde BIS ile pozitif korelasyon gösteren doza bağlı bir etkiye sahip olduğu saptanmıştır.…”

Section: Güncel Ağri Moni̇töri̇zasyon Metotlari/ci̇hazlari Ve çAlişma...unclassified

“…Pupil çapının noksius uyaranlarla arttığı, opioid uygulamasıyla azaldığı, propofolün pupil çapı üzerinde BIS ile pozitif korelasyon gösteren doza bağlı bir etkiye sahip olduğu saptanmıştır. 41,42 Ayrıca neostigmin kullanımı, göz bebeği hastalıkları (Horner ve Holmes-Adie sendromları), gözü ve okülomotor siniri etkileyen hastalıklar ile körlükten etkilenebilir. Ek olarak, ölçüm yapılırken ortam ışığı koşullarına da dikkat edilmelidir.…”

Section: Güncel Ağri Moni̇töri̇zasyon Metotlari/ci̇hazlari Ve çAlişma...unclassified

Monitoring of Analgesia Level During General Anesthesia: Traditional Review

ARPACI,

IŞIK

2023

Turkiye Klinikleri J Anest Reanim

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Nozizeptionsmonitoring

Nitzschke

Fischer²,

Funcke³

2021

Anaesthesist

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Pharmacodynamic modelling of the effect of remifentanil using the Pupillary Pain Index

Cited by 7 publications

References 17 publications

Semimechanistic models to relate noxious stimulation, movement, and pupillary dilation responses in the presence of opioids

Semimechanistic models to relate noxious stimulation, movement, and pupillary dilation responses in the presence of opioids

Monitoring of Analgesia Level During General Anesthesia: Traditional Review

Nozizeptionsmonitoring

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