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

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 (57.43mA vs 32.29mA, P<.0005). Pupil variation in response to the nociceptive stimulations was significantly reduced after opioid administration (8mm vs 28mm, 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 113mmHg, P=.001) and after opioid administration (HR 63 vs 62/min, P=.4; SBP 98.66 vs 93.77mmHg, 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.