Articles: reflex-drug-effects.
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Anesthesia and analgesia · Mar 2017
Multicenter StudyPrediction of Opioid Analgesic Efficacy by Measurement of Pupillary Unrest.
Pupillary unrest under ambient light (PUAL) is the fluctuation in pupil diameter in time around a mean value. PUAL is augmented by light and diminished by administration of opioids. We hypothesized that, because pupillary unrest is a marker of opioid effect, low levels of PUAL may be associated with reduced opioid efficacy, as measured by changes in the numerical rating scale (NRS) pain scores of patients in the postanesthesia care unit (PACU). ⋯ We observe that the pretreatment magnitude of PUAL is correlated with the analgesic response to opioid therapy, and that patients who exhibit higher levels of PUAL change after opioid administration have a more beneficial analgesic effect from opioids. Larger studies with uniform measurement protocols are required to confirm these preliminary results.
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Case Reports
Monitoring of the intraoperative analgesia by pupillometry during laparoscopic splenectomy for splenic hydatid cyst.
Echinococcosis causes a hydatid cyst, a worldwide disease. Human beings are intermediate hosts, but dogs complete the life cycle of the cestode. The most common presentation sites are the liver and lungs. ⋯ This is regulated by the autonomous sympathetic system. It appears to be more sensitive and reliable than using simple variations in heart rate and blood pressure. It is an easy and safe to use method that might allow a reduction in postoperative analgesic requirements.
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Anisocoria and abnormality of pupil- lary light reflex may indicate sight-threatening or life- threatening neurological injury. Many perioperative patients are given opioids for analgesia, and opioids produce miosis and make it hard to assess anisocoria or pupillary light reflex. This study was designed to determine the influence of induction of anesthesia on pupillary light reflex assessed by a hand-held point- and-shoot pupillometer. ⋯ Propofol and remifentanil infusion in- fluence pupillary light reflex and decreases values of NPI and CV. When using these drugs, it is necessary to perform neurologic evaluation using NPI and CV.
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Experimental evidence correlates anesthetic exposure during early development with neuronal and glial injury and death, as well as behavioral and cognitive impairments, in young animals. Several, although not all, retrospective human studies of neurocognitive and behavioral disorders after childhood exposure to anesthesia suggest a similar association. Few studies have specifically investigated the effects of infant anesthesia exposure on subsequent neurobehavioral development. Using a highly translational nonhuman primate model, the authors investigated the potential dose-dependent effects of anesthesia across the first year of development. ⋯ Neonatal exposure to isoflurane, particularly when repeated, has long-term behavioral consequences affecting both motor and socioemotional aspects of behavior.