title: The effects of anesthetic agents on pupillary function during general anesthesia using the automated infrared quantitative pupillometer.
abstract: 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.
authors: Operating Rooms, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. shiron@kuaccm.med.kyushu-u.ac.jp.
authors: Kazuhiro
authors: K
authors: Shirozu
authors: Operating Rooms, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
authors: Hidekazu
authors: H
authors: Setoguchi
authors: Intensive Care Unit, Kyushu University Hospital, Fukuoka, Japan.
authors: Kentaro
authors: K
authors: Tokuda
authors: Department of Anesthesiology and Critical Care Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan.
authors: Yuji
authors: Y
authors: Karashima
authors: Operating Rooms, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
authors: Mizuko
authors: M
authors: Ikeda
authors: Department of Surgery and Oncology, Kyushu University Hospital, Fukuoka, Japan.
authors: Makoto
authors: M
authors: Kubo
authors: Department of Surgery and Oncology, Kyushu University Hospital, Fukuoka, Japan.
authors: Katsuya
authors: K
authors: Nakamura
authors: Department of Anesthesiology and Critical Care Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan.
authors: Sumio
authors: S
authors: Hoka
mesh_terms: D000769:Anesthesia, Inhalation / Q000379:methods; D000771:Anesthesia, Intravenous / Q000379:methods; D000777:Anesthetics / Q000008:administration & dosage*; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D015331:Cohort Studies; D000077335:Desflurane; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D007530:Isoflurane / Q000008:administration & dosage / Q000031:analogs & derivatives; D008738:Methyl Ethers / Q000008:administration & dosage; D010363:Pattern Recognition, Automated; D010880:Piperidines / Q000008:administration & dosage; D015742:Propofol / Q000008:administration & dosage; D011680:Pupil / Q000187:drug effects*; D012044:Regression Analysis; D000077208:Remifentanil; D000077149:Sevoflurane; D012815:Signal Processing, Computer-Assisted; D013055:Spectrophotometry, Infrared / Q000379:methods*
chemical_list: D000777:Anesthetics; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D010880:Piperidines; D000077149:Sevoflurane; D000077335:Desflurane; D007530:Isoflurane; D000077208:Remifentanil; D005283:Fentanyl; D015742:Propofol
keywords: NPi; Pupil reactivity; Quantitative pupillometer