The effects of anesthetic agents on pupillary function during general anesthesia using the automated infrared quantitative pupillometer.
Pupil reactivity can be used to evaluate central nervous system function and can be measured using a quantitative pupillometer. However, whether anesthetic agents affect the accuracy of the technique remains unclear. We examined the effects of anesthetic agents on pupillary reactivity. Thirty-five patients scheduled for breast or thyroid surgery were enrolled in the study. Patients were divided into four groups based on the technique used to maintain anesthesia: a sevoflurane-remifentanil (SEV/REM) group, a sevoflurane (SEV) group, a desflurane-remifentanil (DES/REM) group, and a propofol-remifentanil (PRO/REM) group. We measured maximum resting pupil size (MAX), reduction pupil size ratio (%CH), latency duration (LAT) and neurological pupil index (NPi). A marked reduction in MAX and %CH compared with baseline was observed in all groups, but LAT was unchanged during surgery. NPi reduced within the first hour of surgery in the SEV/REM, SEV, and DES/REM groups, but was not significantly different in the PRO/REM group. Compared with the PRO/REM group, mean %CH and NPi in patients anesthetized with SEV/REM, SEV or DES/REM were markedly lower at 1 h after surgery had commenced. There was no correlation between NPi and bispectral index. Fentanyl given alone decreased pupil size and %CH in light reflex, but did not change the NPi. NPi was decreased by inhalational anesthesia not but intravenous anesthesia. The difference in pupil reactivity between inhalational anesthetic and propofol may indicate differences in the alteration of midbrain reflexs in patients under inhalational or intravenous anesthesia.
['Shirozu|Kazuhiro|K|', 'Setoguchi|Hidekazu|H|', 'Tokuda|Kentaro|K|', 'Karashima|Yuji|Y|', 'Ikeda|Mizuko|M|', 'Kubo|Makoto|M|', 'Nakamura|Katsuya|K|', 'Hoka|Sumio|S|']
D000769:Anesthesia, Inhalation D000771:Anesthesia, Intravenous D000777:Anesthetics D018685:Anesthetics, Inhalation D018686:Anesthetics, Intravenous D015331:Cohort Studies D000077335:Desflurane D005283:Fentanyl D006801:Humans D007530:Isoflurane D008738:Methyl Ethers D010363:Pattern Recognition, Automated D010880:Piperidines D015742:Propofol D011680:Pupil D012044:Regression Analysis D000077208:Remifentanil D000077149:Sevoflurane D012815:Signal Processing, Computer-Assisted D013055:Spectrophotometry, Infrared
Quantitative pupillometer Pupil reactivity NPi