Amorim, Pedro

Cabral, Tiago

Correia, Rui P.

Nunes, Catarina S.

Soares, Maria

Vide, Sérgio

English

Repositório Aberto da Universidade Aberta

Print CloseA2020October 22, 2017 43030.375 - 43030.5Room Exhibit Hall B2Pupillary Pain Index Correlates in Increasing Concentrations of RemifentanilSergio Vide, M.D., Catarina S. Nunes, Ph.D., Rui P. Correia, D.Eng., Tiago Cabral, M.D., Maria Soares, M.D., Pedro P. Amorim, M.D.ULSM, Hospital Pedro Hispano, Matosinhos, PortugalDisclosures: S. Vide: None. C.S. Nunes: None. R.P. Correia: None. T. Cabral: None. M. Soares: None. P.P. Amorim: None.Background:The importance of personalized medicine is becoming increasingly recognized. Titration of the different drugs used in anesthesiology has become possible due to monitors that allow us to measure the different effects. However, regarding the analgesic effect, there are not many available solutions yet. The Pupillary Reflex Dilation has been studied as a surrogate for measuring the nociception/antinociception balance of patients, both in the operating theatre as well as in intensive care (1). The aim of this study, was to assess the Pupillary Pain Index (PPI) association with different concentrations of remifentanil.Methods:This was an observational prospective study, where 34 consecutive patients were enrolled. Patients scheduled for neurosurgical procedures, with general TIVA anesthesia with propofol and remifentanil were considered when no premedication was used. Induction began with an infusion of remifentanil targeted for a constant concentration using Minto PK Model and then an infusion of propofol at 200 ml/h was started until loss of consciousness was observed. Afterwards, an infrared portable pupillometer (AlgiScan® - IDMed, France) was used to assess the Pupillary Dilation Reflex and its derived index: Pupillary Pain Index (PPI). Following this measurement, remifentanil concentrations could be increased or decreased if deemed necessary by the anesthesiologist. The PPI consists in measuring the pupillary dilation in response to a continuously increasing electric stimulus discharge, that stops when >13% dilation from baseline is achieved, or when 60 mA is reached. PPI measurements were taken after loss of consciousness and before surgery, at moments when no other stimulus were present. For each measure of PPI the predicted effect-site concentration (EC) of remifentanil (Minto PK model) and of propofol (Schnider PK Model); and the BIS value were noted. Data are mean±SD or %.Results:A total of 78 measures of PPI were done. Patients’ data were: 57±15years; 73±21Kg; 162±8cm; 60% female; 11.5% ASA I; 80.8% ASA II; Remifentanil EC 2.4±1.5ng/ml; propofol EC 3.7±1.3 ug/ml; BIS 46.1±8.2; PPI 4.8±3. A correlation was observed between the remifentanil EC and PPI (R=-0.46, p<0.001), but not between PPI and propofol EC or BIS. A correlation was observed between BIS and propofol CE (R=-0.26, p=0.028), but not with remifentanil. Tukey HSD test showed that the different is mainly due to concentrations <3 ng/ml versus ≥3 ng/ml.Conclusions:We showed a significant correlation between the remifentanil concentration and PPI, showing that PPI responds to different levels of analgesia. While no correlation was found with propofol or BIS. However, there was no clear discrimination between all levels of remifentanil concentrations analyzed. Further research should be done, with more data and more stratified levels of remifentanil.References: 1Br J Anaesth. 2003,91:347-52Acknowledgements: LAETA-INEGIASA Abstracts - Print Article Page 1 of 4http://www.asaabstracts.com/strands/asaabstracts/printAbstract.htm?index=0&year=2… 16/11/2017Figure 1 Copyright © 2017 American Society of AnesthesiologistsASA Abstracts - Print Article Page 2 of 4http://www.asaabstracts.com/strands/asaabstracts/printAbstract.htm?index=0&year=2… 16/11/2017Filename:  C:/ASA/content/asaabstracts/2017/EQUIPMENT, MONITORING AND ENGINEERING TECHNOLOGY/abs_a5054.htmASA Abstracts - Print Article Page 3 of 4http://www.asaabstracts.com/strands/asaabstracts/printAbstract.htm?index=0&year=2… 16/11/2017ASA Abstracts - Print Article Page 4 of 4http://www.asaabstracts.com/strands/asaabstracts/printAbstract.htm?index=0&year=2… 16/11/2017

Pupillary pain index correlates in increasing concentrations of remifentanil

Vide, Sergio

Amorim, Pedro P.

The Repositório Aberto

Print Close
A2020
October 22, 2017 
43030.375 - 43030.5
Room Exhibit Hall B2
Pupillary Pain Index Correlates in Increasing Concentrations of Remifentanil
Sergio Vide, M.D., Catarina S. Nunes, Ph.D., Rui P. Correia, D.Eng., Tiago Cabral, M.D., Maria Soares, 
M.D., Pedro P. Amorim, M.D.
ULSM, Hospital Pedro Hispano, Matosinhos, Portugal
Disclosures: S. Vide: None. C.S. Nunes: None. R.P. Correia: None. T. Cabral: None. M. Soares: None. 
P.P. Amorim: None.
Background:The importance of personalized medicine is becoming increasingly recognized. Titration of the 
different drugs used in anesthesiology has become possible due to monitors that allow us to measure the 
different effects. However, regarding the analgesic effect, there are not many available solutions yet. The 
Pupillary Reflex Dilation has been studied as a surrogate for measuring the nociception/antinociception 
balance of patients, both in the operating theatre as well as in intensive care (1). The aim of this study, was 
to assess the Pupillary Pain Index (PPI) association with different concentrations of remifentanil.
Methods:This was an observational prospective study, where 34 consecutive patients were enrolled. 
Patients scheduled for neurosurgical procedures, with general TIVA anesthesia with propofol and 
remifentanil were considered when no premedication was used. Induction began with an infusion of 
remifentanil targeted for a constant concentration using Minto PK Model and then an infusion of propofol at 
200 ml/h was started until loss of consciousness was observed. Afterwards, an infrared portable 
pupillometer (AlgiScan® - IDMed, France) was used to assess the Pupillary Dilation Reflex and its derived 
index: Pupillary Pain Index (PPI). Following this measurement, remifentanil concentrations could be 
increased or decreased if deemed necessary by the anesthesiologist. The PPI consists in measuring the 
pupillary dilation in response to a continuously increasing electric stimulus discharge, that stops when >13% 
dilation from baseline is achieved, or when 60 mA is reached. PPI measurements were taken after loss of 
consciousness and before surgery, at moments when no other stimulus were present. For each measure of 
PPI the predicted effect-site concentration (EC) of remifentanil (Minto PK model) and of propofol (Schnider 
PK Model); and the BIS value were noted. Data are mean±SD or %.
Results:A total of 78 measures of PPI were done. Patients’ data were: 57±15years; 73±21Kg; 162±8cm; 
60% female; 11.5% ASA I; 80.8% ASA II; Remifentanil EC 2.4±1.5ng/ml; propofol EC 3.7±1.3 ug/ml; BIS 
46.1±8.2; PPI 4.8±3. A correlation was observed between the remifentanil EC and PPI (R=-0.46, p<0.001), 
but not between PPI and propofol EC or BIS. A correlation was observed between BIS and propofol CE 
(R=-0.26, p=0.028), but not with remifentanil. Tukey HSD test showed that the different is mainly due to 
concentrations <3 ng/ml versus ≥3 ng/ml.
Conclusions:We showed a significant correlation between the remifentanil concentration and PPI, showing 
that PPI responds to different levels of analgesia. While no correlation was found with propofol or BIS. 
However, there was no clear discrimination between all levels of remifentanil concentrations analyzed. 
Further research should be done, with more data and more stratified levels of remifentanil.
References: 1Br J Anaesth. 2003,91:347-52Acknowledgements: LAETA-INEGI
ASA Abstracts - Print Article Page 1 of 4
http://www.asaabstracts.com/strands/asaabstracts/printAbstract.htm?index=0&year=2… 16/11/2017
Figure 1 
Copyright © 2017 American Society of Anesthesiologists
ASA Abstracts - Print Article Page 2 of 4
http://www.asaabstracts.com/strands/asaabstracts/printAbstract.htm?index=0&year=2… 16/11/2017
Filename:  
C:/ASA/content/asaabstracts/2017/EQUIPMENT, MONITORING AND ENGINEERING 
TECHNOLOGY/abs_a5054.htm
ASA Abstracts - Print Article Page 3 of 4
http://www.asaabstracts.com/strands/asaabstracts/printAbstract.htm?index=0&year=2… 16/11/2017
ASA Abstracts - Print Article Page 4 of 4
http://www.asaabstracts.com/strands/asaabstracts/printAbstract.htm?index=0&year=2… 16/11/2017


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Pupillary pain index correlates in increasing concentrations of remifentanil

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