Pupillometry-guided Intraoperative Remifentanil Administration versus Standard Practice Influences Opioid Use A Randomized Study
Pupillometry-guided Intraoperative Remifentanil Administration versus Standard Practice Influences Opioid Use A Randomized Study
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DOI：
10.1097/aln.0000000000001705
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发表时间：
2017-08-01
期刊：
影响因子：
8.8
通讯作者：
Constant, Isabelle
中科院分区：
文献类型：
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作者：
Sabourdin, Nada;Barrois, Jerome;Constant, Isabelle
背景：瞳孔测量在评估麻醉患者的伤害感受方面显示出有希望的结果。然而，其在临床实践中的益处尚未得到证实。这项前瞻性随机研究的目的是评估术中瞳孔测量监测对大型妇科手术围手术期阿片类药物消耗的影响。 方法：在获得伦理委员会批准和患者书面同意后，美国麻醉医师协会 I 至 II 级接受妇科手术的女性被纳入这项单盲、前瞻性、平行随机研究。全身麻醉采用丙泊酚-瑞芬太尼靶控输注进行标准化。患者被随机分为两组。在瞳孔测量组中，瑞芬太尼的给药是根据瞳孔直径的变化来指导的。在标准组中，瑞芬太尼的给药由麻醉师自行决定。主要结局是术中瑞芬太尼的消耗量。结果：对 55 名患者进行了分析。瞳孔测量组的瑞芬太尼消耗量显着减少（3.8 [3.4至4.8 μ g kg(-1) h(-1)] vs. 7.9 μ g kg(-1) h(-1) [6.5至9.0 μ g kg(-1) h(-1)]标准组；差异 = 4.2 μ g kg-1 h(-1) [95% CI, 3.0 to 5.3μg·kg(-1)·h(-1)];P<0.001)。瞳孔测量组的 0 至 12 小时累计吗啡消耗量有所减少（双向重复测量方差分析 0.3 +/- 0.1 与 0.4 +/- 0.2 mg/kg；P = 0.048）。术后 3 个月的电话调查显示，标准组 29 名患者中有 15 名仍经历手术相关疼痛，而瞳孔测量组 23 名患者中有 3 名仍经历手术相关疼痛（卡方 P = 0.037）。研究期间未观察到与瞳孔测量相关的不良事件。结论：使用瞳孔测量指导术中镇痛减少了术中瑞芬太尼的消耗量和术后吗啡的需求量。术中减少瑞芬太尼对慢性疼痛的可能后果需要进一步研究。
Background: Pupillometry has shown promising results for assessing nociception in anesthetized patients. However, its benefits in clinical practice are not demonstrated. The aim of this prospective randomized study was to evaluate the impact of intraoperative pupillometry monitoring on perioperative opioid consumption in major gynecologic surgery.Methods: After receiving ethics committee approval and written consent of patients, American Society of Anesthesiologists status I to II women undergoing gynecologic surgery were included in this single-blinded, prospective, parallel-arm randomized study. General anesthesia was standardized with propofol-remifentanil target-controlled infusion. Patients were randomly assigned into two groups. In the pupillometry group, remifentanil administration was guided by pupillary diameter changes. In the standard group, remifentanil administration was left to the discretion of the anesthesiologist. The primary outcome was intraoperative remifentanil consumption.Results: Fifty-five patients were analyzed. Remifentanil consumption was markedly decreased in the pupillometry group (3.8 [3.4 to 4.8 mu g kg(-1) h(-1)] vs. 7.9 mu g kg(-1) h(-1) [6.5 to 9.0 mu g kg(-1) h(-1)] in the standard group; difference = 4.2 mu g kg-1 h(-1) [95% CI, 3.0 to 5.3 mu g kg(-1) h(-1)]; P < 0.001). Cumulative 0-to 12-h morphine consumption was reduced in the pupillometry group (two-way repeated measures ANOVA 0.3 +/- 0.1 vs. 0.4 +/- 0.2 mg/kg; P = 0.048). A telephone survey 3 months after surgery revealed that 15 of 29 patients in the standard group still experienced procedure-related pain versus 3 of 23 in the pupillometry group (chi-square P = 0.037). No adverse events associated with pupillometry were observed during the study.Conclusions: The use of pupillometry to guide intraoperative analgesia reduced intraoperative remifentanil consumption and postoperative morphine requirements. The possible consequences of decreasing intraoperative remifentanil in terms of chronic pain require further investigation.