Reflexo de dilatação pupilar e a mensuração da dor no paciente anestesiado: revisão de literatura

Autores

DOI:

https://doi.org/10.34024/rnc.2021.v29.12438

Palavras-chave:

sedoanalgesia, reflexo pupilar, pupilometria

Resumo

Introdução. A validação da presença de dor em pacientes sob anestesia geral permanece um desafio. A correta mensuração da sedoanalgesia pode proporcionar o uso de doses mínimas para ser atingido, evitando-se subdosagens ou superdosagens. Estudos recentes têm correlacionado a pupilometria com o nível de dor no paciente não comunicativo. Objetivos. Por meio de uma revisão bibliográfica, procuramos correlacionar a pupilometria e o reflexo de dilatação pupilar na monitorização da analgesia, no paciente sedado e não comunicativo, sob o uso de opioides e hipnóticos, bem como comparar a pupilometria com o uso de parâmetros vitais como frequência cardíaca, uso do índice de analgesia e nocicepção e o BIS. Método. Foi realizada uma revisão bibliográfica na plataforma “PubMed”, em inglês, espanhol e português, entre o período de 1996 a 2020. A busca nas bases mencionadas resultou em 38 artigos. Resultados. Verificou-se que a pupilometria apresentou dados mais confiáveis na avaliação da nocicepção quando comparada com frequência cardíaca e pressão arterial, porém ainda há dificuldade de padronização de aplicação. A pupilometria mede diversos componentes: amplitude máxima, latência, velocidade de dilatação e contração, e tamanho máximo e mínimo. Quando avaliados os sinais vitais como frequência cardíaca e pressão arterial a pupilometria tem se mostrado um melhor preditor de analgesia, tornando-se um melhor indicador para a titulação, quando utilizados remifentanil ou propofol.  Conclusões. A avaliação do reflexo de dilatação pupilar permite a mensuração da reatividade do sistema nervoso autônomo ao estímulo da dor, podendo proporcionar tratamento individualizado e com maior segurança.

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Referências

Gaudillière B, Fragiadakis GK, Bruggner RV, Nicolau M, Finck R, Tingle M, et al. Clinical recovery from surgery correlates with single-cell immune signatures. Sci Translat Med 2014;6:255ra131. https://doi.org/10.1126/scitranslmed.3009701

Alazawi W, Pirmadjid N, Lahiri R, Bhattacharya S. Inflammatory and immune responses to surgery and their clinical impact. Ann Surg 2016;264:73-80. https://doi.org/10.1097/SLA.0000000000001691

Leal PC, Clivatti J, Garcia JBS, Sakata RK. Hiperalgesia induzida por opioides (HIO). Rev Bras Anestesiol 2010;60:643-7. https://doi.org/10.1590/S0034-70942010000600011

Kim SH, Stoicea N, Soghomonyan S, Bergese SD. Remifentanil—Acute Opioid Tolerance and Opioid-Induced Hyperalgesia: A Systematic Review. Am J Therap 2015;22:e62-74. https://doi.org/10.1097/MJT.0000000000000019

Huhle R, Burghardt M, Zaunseder S, Wessel N, Koch T, Malberg H, et al. Effects of awareness and nociception on heart rate variability during general anaesthesia. Physiol Meas 2012;33:207. https://doi.org/10.1088/0967-3334/33/2/207

Sabourdin N, Diarra C, Wolk R, Piat V, Louvet N, Constant I. Pupillary pain index changes after a standardized bolus of alfentanil under sevoflurane anesthesia: first evaluation of a new pupillometric index to assess the level of analgesia during general anesthesia. Anest Analg 2019;128:467-74. https://doi.org/10.1213/ANE.0000000000003681

Sabourdin N, Barrois J, Louvet N, Rigouzzo A, Guye ML, Dadure C, et al. Pupillometry-guided intraoperative remifentanil administration versus standard practice influences opioid use: a randomized study. Anesthesiol 2017;127:284-92.

https://doi.org/10.1097/ALN.0000000000001705

Aissou M, Snauwaert A, Dupuis C, Atchabahian A, Aubrun F, Beaussier M. Objective assessment of the immediate postoperative analgesia using pupillary reflex measurement: a prospective and observational study. J Am Soc Anesthesiol 2012;116:1006-12. https://doi.org/10.1097/ALN.0b013e318251d1fb

Chapman CR, Oka S, Bradshaw DH, Jacobson RC, Donaldson GW. Phasic pupil dilation response to noxious stimulation in normal volunteers: relationship to brain evoked potentials and pain report. Psychophysiol 1999;36:44-52.

https://doi.org/10.1017/s0048577299970373

Duceau B, Baubillier M, Bouroche G, Albi-Feldzer A, Jayr C. Pupillary reflex for evaluation of thoracic paravertebral block: a prospective observational feasibility study. Anest Analg 2017;125:1342-7. https://doi.org/10.1213/ANE.0000000000002003

Guglielminotti J, Grillot N, Paule M, Mentré F, Servin F, Montravers P, et al. Prediction of movement to surgical stimulation by the pupillary dilatation reflex amplitude evoked by a standardized noxious test. Anesthesiol 2015;122:985-93.

https://doi.org/10.1097/ALN.0000000000000624

Heimburger D, Durand M, Gaide-Chevronnay L, Dessertaine G, Moury PH, Bouzat P, et al. Quantitative pupillometry and transcranial Doppler measurements in patients treated with hypothermia after cardiac arrest. Resuscitation 2016;103:88-93. https://doi.org/10.1016/j.resuscitation.2016.02.026

Anderson TA, Segaran JR, Toda C, Sabouri AS, De Jonckheere J. High-frequency heart rate variability index: a prospective, observational trial assessing utility as a marker for the balance between analgesia and nociception under general anesthesia. Anest Analg 2020;130:1045-53.

https://doi.org/10.1213/ANE.0000000000004180

Boselli E, Bouvet L, Bégou G, Dabouz R, Davidson J, Deloste JY, et al. Prediction of immediate postoperative pain using the analgesia/nociception index: a prospective observational study. Bri J Anaest 2014;112:715-21. https://doi.org/10.1093/bja/aet407

Charier D, Vogler MC, Zantour D, Pichot V, Martins-Baltar A, Courbon M, et al. Assessing pain in the postoperative period: Analgesia Nociception IndexTM versus pupillometry. Bri J Anaest 2019;123:e322-7. https://doi.org/10.1016/j.bja.2018.09.031

Rommel D, Nandrino JL, Jeanne M, Logier R. Heart rate variability analysis as an index of emotion regulation processes: Interest of the Analgesia Nociception Index (ANI). In: Annual International Conference of the IEEE Engineering in Medicine and Biology Society 2012:3432-5. https://doi.org/10.1109/EMBC.2012.6346703

Turan G, Ar AY, Kuplay YY, Demiroluk O, Gazi M, Akgun N, et al. Analgesia Nociception Index for perioperative analgesia monitoring in spinal surgery. Braz J Anesthesiol 2017;67:370-5. https://doi.org/10.1016/j.bjan.2017.03.004

Jacobi J, Fraser GL, Coursin DB, Riker RR, Fontaine D, Wittbrodt ET, et al. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med 2002;30:119-41. https://doi.org/10.1097/00003246-200201000-00020

Moritz RD. Sedação e analgesia em UTI: velhos fármacos, novas tendências. Rev Bras Ter Intensiva 2005;17:52-5. http://www.amib.com.br/rbti/download/artigo_2010617173859.pdf

Ostermann ME, Keenan SP, Seiferling RA, Sibbald WJ. Sedation in the intensive care unit: a systematic review. Jama 2000;283:1451-9. https://doi.org/10.1001/jama.283.11.1451

Yildirim V, Doganci S, Bolcal C, Oz BS, Kucukarslan N, Cosar A, et al. Combination sedoanalgesia with remifentanil and propofol versus remifentanil and midazolam for elective cardioversion after coronary artery bypass grafting. Adv Ther 2007;24:662-70. https://doi.org/10.1007/BF02848791

Barvais L, Engelman E, Eba JM, Coussaert E, Cantraine F, Kenny GN. Effect site concentrations of remifentanil and pupil response to noxious stimulation. Bri J Anaest 2003;91:347-52. https://doi.org/10.1007/BF02848791

Sabourdin N, Peretout JB, Khalil E, Guye ML, Louvet N, Constant I. Influence of depth of hypnosis on pupillary reactivity to a standardized tetanic stimulus in patients under propofol-remifentanil target–controlled infusion: a crossover randomized pilot study. Anest Analg 2018;126:70-7. https://doi.org/10.1213/ANE.0000000000001802

Weinbroum AA, Rudick V, Sorkine P, Freedman M, Geller E, Halpern P. Midazolam versus propofol for long-term sedation in the ICU: a randomized prospective comparison. Intens Care Med 1997;23:1258-63. https://doi.org/10.1007/s001340050495

Guignard B. Monitoring analgesia. Best Pract Res Clin Anaesthesiol 2006;20:161-80. https://doi.org/10.1016/j.bpa.2005.09.002

Pomfrett CJ. Heart rate variability, BIS and depth of anaesthesia. BJA 1999;82:659-62. https://doi.org/10.1093/bja/82.5.659

Logier R, Jeanne M, Dassonneville A, Delecroix M, Tavernier B. PhysioDoloris: a monitoring device for analgesia/nociception balance evaluation using heart rate variability analysis. In: Annual International Conference of the IEEE Engineering in Medicine and Biology 2010:1194-7. https://doi.org/10.1109/IEMBS.2010.5625971

Delecroix M, Jeanne M, Keribedj A, Couturier N, Logier R. Automated analgesic drugs delivery guided by vagal tone evaluation: Interest of the Analgesia Nociception Index (ANI). In: 35th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC) 2013:1952-5. https://doi.org/10.1109/EMBC.2013.6609910

Abdullayev R, Yildirim E, Celik B, Sarica LT. Analgesia Nociception Index: heart rate variability analysis of emotional status. Cureus 2019;11:e4365. https://doi.org/10.7759/cureus.4365

Jeanne M, Logier R, De Jonckheere J, Tavernier B. Heart rate variability during total intravenous anesthesia: effects of nociception and analgesia. Auton Neurosci 2009;147:91-6. https://doi.org/10.1016/j.autneu.2009.01.005

Jeanne M, Clément C, De Jonckheere J, Logier R, Tavernier B. Variations of the analgesia nociception index during general anaesthesia for laparoscopic abdominal surgery. J Clin Monit Comp 2012;26:289-94. https://doi.org/10.1007/s10877-012-9354-0

Hamblin MR. Shining light on the head: photobiomodulation for brain disorders. BBA Clin 2016;6:113-24. https://doi.org/10.1016/j.bbacli.2016.09.002

Dias AG. Pupilometria dinâmica: uma proposta de rastreamento da posição e tamanho da pupila humana em tempo real. Uberlândia, Universidade Federal de Uberlândia, 2014. https://repositorio.ufu.br/handle/123456789/14625

Leon-Sarmiento FE, Prada DG, Gutiérrez C. Pupila, pupilometría y pupilografía. Acta Neurol Colomb 2008;24:188-97. http://www.acnweb.org/acta/2008_24_4_188.pdf

Larson MD, Tayefeh F, Sessler DI, Daniel M, Noorani M. Sympathetic nervous system does not mediate reflex pupillary dilation during desflurane anesthesia. J Am Soc Anesthesiol 1996;85:748-54. https://doi.org/10.1213/ANE.0000000000004173

Larson MD. Mechanism of opioid-induced pupillary effects. Clin Neurophysiol 2008;119:1358-64. https://doi.org/10.21454/rjaic.7518.251.wil

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Publicado

2021-12-17

Como Citar

Brait, A. B. F., Reis, B. A., Lemos, B. D., Fernandes, I. de J., Rocha, B. A. da, & Prandini, M. N. (2021). Reflexo de dilatação pupilar e a mensuração da dor no paciente anestesiado: revisão de literatura. Revista Neurociências, 29, 1–14. https://doi.org/10.34024/rnc.2021.v29.12438

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Artigos de Revisão
Recebido: 2021-07-20
Aceito: 2021-10-27
Publicado: 2021-12-17