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Pupil response to painful stimuli during inhalation anaesthesia without opioids in children

Sang-Hwan Ji1, Sung-Ae Cho2, Young-Eun Jang1

  • 1Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.

Acta Anaesthesiologica Scandinavica
|April 11, 2022
PubMed

Insights

Pupil dilation and decreased neurological pupil index (NPi) indicate noxious stimuli response in children during sevoflurane anesthesia with acetaminophen. These pupil changes occurred regardless of sufficient pain relief, suggesting their utility in monitoring pediatric surgical patients.

Area of Science:

  • Anesthesiology
  • Pediatric Surgery
  • Pain Management

Background:

  • Pupillometry is a valuable tool for assessing responses to perioperative pain in children.
  • It can guide anesthesia and potentially reduce opioid use.
  • However, pupil response data during inhalation anesthesia with intravenous acetaminophen in children is lacking.

Purpose of the Study:

  • To investigate pupil response to noxious stimuli during general anesthesia with sevoflurane and acetaminophen in children.
  • To evaluate the utility of pupillometry in assessing analgesia adequacy.

Main Methods:

  • A prospective study included 33 children (3-12 years) undergoing surgery.
  • Anesthesia was maintained with sevoflurane (1 MAC) and acetaminophen (15 mg/kg).
  • Pupillometry measured pupil diameter and neurological pupil index (NPi) at various surgical stages.

Main Results:

  • Enlarged pupils, increased diameter, and low NPi after skin incision indicated insufficient analgesia.
  • Abnormal NPi values were observed in children with inadequate pain relief.
  • Pupil dilation and NPi decrease occurred even without heart rate increase, suggesting sensitivity to stimuli.

Conclusions:

  • Pupil dilation and decreased NPi can signal responses to noxious stimuli in pediatric patients.
  • These pupillometric changes were observed after skin incision, irrespective of analgesia sufficiency.
  • Pupillometry offers a potential method for monitoring noxious stimuli during anesthesia in children.
Abstract

Keywords:
paediatric Anaesthesiapain responsepupillometersevoflurane

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