The use of pupillometry as monitoring of intraoperative analgesia in the consumption of analgesics during the first 12hours after surgery

Torrent, Anna Abad; Bustamante, Vania; Fons, N. Carrasco; Tutusaus, F.J. Roca; Vargas, D. Blanco; García, Carmen Isabel Gómez

doi:10.1016/j.redare.2015.12.003

Cited by 8 publications

(4 citation statements)

References 28 publications

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“…The beneficial effects described above also translates into lower postoperative pain scores and opioid consumption for several hours after surgery when these monitors are used. This was consistent when using the pupil diameter monitoring in gynecological surgery, 61,75 when ANI was used during general anesthesia for spine surgery, 71 and when NOL index was used in major abdominal surgery 74 or gynecological surgery. 67…”

Section: Pain and Nociception Monitorssupporting

confidence: 54%

“…70,73 The beneficial effects described above also translates into lower postoperative pain scores and opioid consumption for several hours after surgery when these monitors are used. This was consistent when using the pupil diameter monitoring in gynecological surgery, 61,75 when ANI was used during general anesthesia for spine surgery, 71 and when NOL index was used in major abdominal surgery 74 or gynecological surgery. 67 Regarding the impact of nociception monitoring during general anesthesia on long-term outcomes such as persistent postsurgical pain or opioid use disorders after major surgery, very few studies evaluated these outcomes and were not robust enough to answer this specific question.…”

Section: Middle Latency Evoked Auditory Potentialssupporting

confidence: 52%

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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: Pain and Nociception Monitorssupporting

confidence: 54%

Section: Middle Latency Evoked Auditory Potentialssupporting

confidence: 52%

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

Laferrière-Langlois,

Morisson,

Jeffries

et al. 2024

Anesthesia &Amp; Analgesia

View full text Add to dashboard Cite

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“…During the session, the patient's eye was flooded with infrared light and the reflected images were measured on an infrared sensor, with the variations in pupil size, alongside the pupillary light reflex and pupillary reflex dilatation, being calculated by the instrument and displayed on a screen immediately after each time-stamped measurement. The monitoring of the quality of intraoperative analgesia using pupillometry has proven to be useful in the management of pain because it allows for the assessment of the effect of opioids and the titration of anesthetics [28,29], and it can reduce the intensity of acute postoperative pain perception and analgesic consumption in the first 12 h after major gynecological surgery [30,31].…”

Section: Discussionmentioning

confidence: 99%

Adequacy of Anesthesia and Pupillometry for Endoscopic Sinus Surgery

Stasiowski

Szumera

Wardas

et al. 2021

JCM

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Inadequate intraoperative analgesia causes the deterioration of the condition of the surgical field (CSF) as a result of hemodynamic instability. Analgesia monitors are used to guide remifentanil) infusion to optimize intraoperative analgesia. The main aim of the current randomized controlled trial was to investigate the potential advantages of intraoperative analgesia monitoring using surgical Pleth index (SPI)- or pupillometry (PRD)-guided remifentanil administration for managing the volume of total intraoperative blood loss (TEIBL), CSF, and length of operation (LOP) in comparison with the standard practice in patients undergoing endoscopic sinus surgery (ESS). The 89 patients in our study were grouped as follows: 30 patients were assigned to the general analgesia (GA) group, 31 patients were assigned to the SPI group, and 28 patients were assigned to the PRD group. The speed of remifentanil infusion was accelerated by 50% when SPI, PRD, or BSS were increased by >15 points, >5%, or >2, respectively, in adjacent groups until their normalization. The SPI group showed significantly lower TEIBL in comparison to the GA group (165.2 ± 100.2 vs. 283.3 ± 193.5 mL; p < 0.05) and a higher mean arterial pressure (MAP; 73.9 ± 8 vs. 69.2 ± 6.8 mmHg; p < 0.05). In the PRD group, a shorter LOP compared with the GA group was observed (63.1 ± 26.7 min vs. 82.6 ± 33.1 min; p < 0.05). It was noted that the PRD group had a lower total remifentanil consumption than the SPI group (1.3 ± 1.4 vs. 1.8 ± 0.9 mg; p < 0.05). In ASA I-III patients undergoing ESS, intraoperative monitoring based on state entropy and SPI values can optimize the CSF and reduce TEIBL, whereas monitoring based on state entropy and PRD measurements can optimize the cost effectiveness of anesthetic drugs and the use of the operation room.

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“…Torrent et al did also a study with pupillometry and remifentanil.10 When at 40 mA the pupil dilation was < 6%, the remifentanil dosage was lowered. He had a 1 point reduction of numeric rating scale (NRS) at 3, 6 and 9h postoperative.10 IV morphine consumption at PACU showed a mean dose of 3.7 mg in the pupillometry group versus 6 mg (p < 0.001) in the control group 10 .…”

Section: Introductionmentioning

confidence: 98%

Pupillometry pain index during day care anesthesia using remifentanil: comparison of perioperative analgesic consumption in a double blind RCT

Van Vlaenderen,

Hans,

Saldien

et al. 2022

Acta Anaest Belg

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Background: Communication is impossible in sedated patients. Nowadays there is no single best technology to measure nociception during anesthesia. Objectives: The primary outcome parameter was the postoperative pain intensity queried as pain intensity by numeric rating scale and the amount of pain killer usage. Our hypothesis was that patients with a good titrated remifentanil administration peroperative should have less pain and less need of pain medication. Secondary outcome parameters were the characteristics of the pupillometry introducing a pupillometry pain index chart to individual titrate remifentanil dosage. Tertiary outcome parameters were nausea and vomiting, length of stay at the post anesthesia care unit and health state index. Design and setting: In a single center double blind randomized controlled trial we evaluated if pupillometry controlled use of remifentanil is better than free choice administration of remifentanil by anesthesiologists. Fifty-five patients undergoing elective day care surgery were enrolled. A pupillometry pain index score chart was introduced for remifentanil administration guidance. Methods: After induction, a first pupillary reflex dilation (PRD) measurement was performed using pupillometry. A second identical evaluation was performed six minutes after remifentanil administration and adapted every 10 minutes. Remifentanil dosage was adjusted following the pupillometry pain index score (intervention group) or by the discretion of the anesthesiologist (control group). Results: No statistically significant difference was found in pain intensity and pain killer usage at postoperative day one. The pupillometry pain index chart was usable. Although both groups received 0.21 mcg kg-1 min-1 remifentanil. No Statistically significant difference in opioïd induced side effects, nor health state index was seen. Conclusion: This study showed no additional value for PRD assessment in response to remifentanil administration during daycare procedures with our protocol to titrate remifentanil. A pupillometry pain index score chart could be implemented. Further research to lower the remifentanil administration within this protocol is needed. (Ethics Committee EC17/28/319 of the University Hospital of Antwerp. Registration at clinicaltrials.gov NCT03248908.)

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The use of pupillometry as monitoring of intraoperative analgesia in the consumption of analgesics during the first 12hours after surgery

Cited by 8 publications

References 28 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

Adequacy of Anesthesia and Pupillometry for Endoscopic Sinus Surgery

Pupillometry pain index during day care anesthesia using remifentanil: comparison of perioperative analgesic consumption in a double blind RCT

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