Pupil maximum constriction velocity predicts post-induction hypotension in patients with lower ASA status: a prospective observational study

Abstract

Background Individuals affected by autonomic dysfunction are at a higher risk of developing hypotension following anesthesia induction. Dynamic pupillometry has previously been employed as a means of assessing autonomic function. This prospective observational study was developed to determine whether pupillary light reflex (PLR) parameters can reliably predict post-induction hypotension (PIH). Methods This study enrolled patients with lower ASA status (I-II) undergoing elective surgery. PLR recordings for these patients prior to anesthesia induction were made with an infrared pupil camcorder, with a computer being used to assess Average Constriction Velocity (ACV), Maximum Constriction Velocity (MCV), and Constriction Ratio (CR). PIH was defined by a > 30% reduction in mean arterial pressure (MAP) or any MAP recording < 65 mmHg for at least 1 min from the time of induction until 10 minutes following intubation. Patients were stratified into PIH and non-PIH groups based on whether or not they developed hypotension. Results This study enrolled 61 total patients, of whom 31 (50.8%) exhibited one or more hypotensive episodes. Patients in the PIH group exhibited significantly smaller ACV (P = 0.003) and MCV values (P < 0.001), as well as a higher CR (P = 0.003). Following adjustment for certain factors (Model 2), MCV was identified as a protective factor for PIH (Odds Ratio: 0.369). Receiver operating characteristic (ROC) analyses revealed that relative to CR (AUC: 0.695, 95% CI: 0.563–0.806; P = 0.004), the reciprocal of MCV (1/MCV) offered greater value as a predictor of PIH (AUC: 0.803,95%CI: 0.681–0.894; P < 0.001). Conclusion These results indicate that pupil maximum constriction velocity is a reliable predictor of post-induction hypotension in individuals of ASA I-II status undergoing elective surgery. Trial registration This study was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR2200057164, registration date: 01/03/2022).

Evaluating the utility of quantitative pupillometry in a neuro-critical care setting for the monitoring of intracranial pressure: A prospective cohort study

“…9 The PLR is also a re ection of a patient's autonomic function as demonstrated for example in its ability to predict post-induction hypotension. 29 These phenomena contribute to the noisy nature of this data, in particular given the pragmatic data collection in the setting of a neurocritical care unit. This likely contributes to the limited effect sizes identi ed throughout this study.…”

Dynamically Normalized Pupillometry for Detecting Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage

“…Multiple pathways of the autonomic nervous system, integrating at the midbrain, and projecting to multiple levels of gray matter (locus coeruleus, colliculi, and cingulate cortex) are involved in the potential relationship between cortical activity and the pupillary light reflex (48). Reduced pupillary CV correlates with both cortical dysfunctions in the form of severe encephalopathy or an unreactive electroencephalogram (49), autonomic dysregulation (50)(51)(52), and a depth of sedation (53,54). Although we cannot infer pathophysiologic conclusions from our data, the relationship between a decreased CV relatively to the patient's baseline and DCI might involve direct cortical injury, an autonomic response associated with ischemia or vasospasm (4,55), or the use of sedative agents in response to secondary agitation (56).…”

Effect of pneumatic leg compression on post‐induction hypotension in elderly patients undergoing robot‐assisted laparoscopic prostatectomy: a double‐blind randomised controlled trial

“…An impaired sympathetic nervous system can cause intra-operative hypotension [38,39]. Only a few studies have been conducted on autonomic dysfunction and post-induction hypotension [26,27]. In particular, the QTc interval is affected by autonomic dysfunction [40].…”

“…In elderly patients, postinduction hypotension can more frequently develop and has a greater effect leading to various health problems [21][22][23]. Although there have been various studies on the prevention or prediction of post-induction hypotension [7,18,[24][25][26][27], it remains a major concern of daily anaesthesia practice. While a number of drugs have been evaluated for their effectiveness in prevention of post-induction hypotension, it remains a burden on patients and medical staff [21].…”