Amorim, Pedro

Correia, Rui P.

Leitão, A.

Nunes, Catarina S.

Rego, J.

Soares, Maria

Vide, Sérgio

English

Repositório Aberto da Universidade Aberta

synapsis of the reflexes across the central nervous system. Opioids affect pupilsize, but do seem not alter light reflex amplitude or constriction velocity andpropofol decrease both the amplitude of the light reflex independently of anychange in pupil size.2In this study, we wanted to assess the possibility of using differentcharacteristics of the PLR to predict loss of consciousness.Methods: This is an observational prospective study, where 25 consec-utive patients were enrolled. Patients scheduled for neurosurgical proce-dures, with general total intravenous anesthesia with propofol andremifentanil were considered when no premedication was used. The PLRwas measured using a portable infrared pupillometer (AlgiScan—IDMed, France) before and after loss of consciousness was achieved. Thepupillometer applied a flash of visible light and measured the minimumdiameter obtained afterwards, the response latency and velocity of con-traction. A logistic regression for loss of consciousness was then calcu-lating using these 3 variables. Data are presented as mean±SD.Results: The logistic regression model showed goodness of fit (Hosmerand Lemeshow test P= 0.921). Velocity of contraction was statisticalsignificant (P< 0.001, Exp(B) 0.98).Receiver operating characteristic curve of the predicted probabilitiesyielded an area under the curve of 0.982 (P< 0.001) (Fig. 1).Discussion: From this preliminary results, it seems that some measurementsrelated to the PLR can be used to detect loss of consciousness. However,further studies are needed to assess if it correlates with the time it ensues.References:1. Bosch L, Fernández-Candila J, León A, et al. Revista Española deAnestesiología y Reanimación. 2017;64:157–167.2. Couret D, Boumaza D, Grisotto C, et al. Crit Car 2016;20:99.[SNACC-105] Pupillary Pain Index correlates with PostoperativePain Scores in Neurosurgical PatientsVide S*, Correia R†, Rego J‡, Soares M†, Nunes C§, Leitão A∥, AmorimP†. *Hospital Pedro Hispano, Matosinhos. †Centro Hospitalar Do Porto.§Universidade Aberta. ∥Faculdade De Engenharia Do Porto, Porto.‡Centro Hospitalar Tamega E Sousa, Penafiel, Portugal.Background: Acute postoperative pain, if inadequately treated, not onlylimits mobility and impairs ventilation, but also increases stress hormonesand the risk for chronic postsurgical pain.1 In contrast, if opioids aregiven in excess they can cause respiratory depression, nausea and vom-iting, ileus, sedation and even hyperalgesia.1Adequate titration of analgesia intraoperatively lacks a widely acceptedmonitor. Nevertheless, some studies have addressed this issue by usingsurrogate variables of the autonomic nervous system to guide opioidadministration.2–3 In this study, we recorded the pupillary dilation re-sponse immediately before extubation and compared it with the ratings ofpatient’s pain reported in the postanesthesia care unit (PACU) using avisual analog scale (VAS).4Methods: Pupillary dilation response was determined through pupillom-etry using AlgiScan and its Pupillary Pain Index (PPI). The PPI consistsin measuring the changes in pupillary dilation in response to a con-tinuously increasing electric stimulus discharge, which then assigns scoresfrom 1 (when pupillary dilation is <5% despite maximal tetanic stim-ulation intensity) to 10 (when pupillary dilation rises above 13% with the10mA).3 Twenty-two patients undergoing neurosurgery were included inthis study. General anesthesia was induced and maintained with propofoland remifentanil, titrated to achieve adequate levels of sedation andanalgesia during the medical procedure. PPI measurements were per-formed after propofol was stopped at the end of surgery and beforeextubation. VAS pain assessment was performed at PACU arrival.Correlation analysis between PPI and VAS was assessed using 2-tailedSpearmen test with significance for P< 0.01. Data are presented asmean±SD.Results: Demographics were: 57± 13 years, 68.3± 9.1 kg, 163±8 cm, 9%ASA I, 82% ASA II, 9% ASA III, 15 females and 7 males. Mean PPIbefore extubation was 6.2± 2.5 and VAS at PACU arrival was 5± 2.6.VAS was correlated with PPI (Spearmen R= 0.57, P= 0.006), and couldbe predicted (adjusted R2= 0.41) as VAS= 0.79×PPI+0.046.Conclusions and Discussion: We found a correlation between pre-extubation PPI and the VAS at PACU arrival. This data suggest that PPIcould be used to titrate analgesia in the end of the intraoperative period,targeting optimal analgesia in the immediate postoperative period.References:1. Larson MD, Sessler DI. Anesthesiology 2012;116(5):980–982.2. Boselli E, Bouvet L, Bégou G, et al. Br J Anaesth. 2014;112(4):715–721.Abstracts J Neurosurg Anesthesiol  Volume 29, Number 4, October 2017556 | www.jnsa.com Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.Copyright r 2017 Wolters Kluwer Health, Inc. All rights reserved.3. Maurer CA, Walensi M, Käser SA, et al. World J Hepatol. 2016;8(24):1038–1046.4. Gould D, Kelly D, Goldstone L, et al. J Clin Nurs. 2001;10(5):697–706.[SNACC-106] Clinical Epidemiology of Adults With ModerateTraumatic Brain InjuryWatanitanon A, Lyons V, Lele A, Krishnamoorthy V, Chaikittisilpa N,Chandee T, Vavilala M. University of Washington, Seattle, WA.Background: Moderate traumatic brain injury (TBI) is common but un-like mild or severe TBI, little is known about patients with moderate TBI.The aim was to describe the clinical epidemiology of patients specificallywith moderate TBI.Methods: We examined National Trauma Data Bank (NTDB) data be-tween 2007 and 2014 of adults (age older than 18 y) with moderate TBI(TBI ICD 9 codes and admission Glasgow Coma Scale [GCS] 9 to 13).Demographics, mechanism of injury, hospital course, and facility charac-teristics were examined. Admission characteristics associated with dischargeoutcomes were analyzed using multivariable Poisson regression models.Findings: Of 114,066 patients, most were white (62%), male (69%),and had median admission GCS 12 (IQR, 10-13). The leading injurymechanisms were falls (43%) and motor vehicle-related (34%). Seventy-seven percent had isolated TBI. Concussion, which accounted for 25% ofmoderate TBI, was the most frequent TBI diagnosis. Fourteen percentreceived mechanical ventilation and 66% were admitted to intensive careunit. Over 30% were admitted to a nontrauma center and 50% receivedcare at a community hospital. Seven percent died and 32% had a pooroutcome, including those with GCS 13. Compared with patients 18 to44 years, patients 45 to 64 years were twice as likely (aRR, 1.97; 95% CI,1.92-2.02), and patients over 80 years were 5 times as likely (aRR, 4.66;95% CI, 4.55-4.76) to have a poor outcome. Patients with a poor dis-charge outcome were more likely to have had hypotension at admission(aRR, 1.10; 95% CI, 1.06-1.14), lower admission GCS (aRR, 1.37; 95%CI, 1.34-1.40), higher ISS (aRR, 2.97; 95% CI, 2.86-3.09), and poly-trauma (aRR, 1.05; 95% CI, 1.02-1.07), compared with those withoutpoor discharge outcomes.Interpretation: Many patients with moderate TBI deteriorate, requireneurocritical care, and experience poor outcomes, but do not receive careat a trauma center.[SNACC-107] Awake Craniotomy for Cerebral Abscess in aPatient With Unrepaired Cyanotic Congenital Heart DiseaseGoettel N, Hofer A, D’Antico C, Tobler D, Zumofen D, Steiner L.University Hospital Basel, Basel, Switzerland.We report the case of a 39-year-old male with complex cyanotic con-genital heart disease undergoing emergency craniotomy for a cerebralabscess. Maintenance of intraoperative hemodynamic stability andadequate tissue oxygenation during anesthesia may be challenging inpatients with cyanotic congenital heart disease. In this case, we decided toperform the surgery as an awake craniotomy after interdisciplinaryconsensus. We discuss general aspects of anesthetic management duringawake craniotomy and specific concerns in the perioperative care ofpatients with congenital heart disease.[SNACC-108] High Spinal Block in a Patient With a PreexistingVentriculo-Peritoneal Shunt for Normal Pressure HydrocephalusYoung D, Trudeau J, Tang R, Flexman A. University of BritishColumbia, Vancouver, BC, Canada.Spinal anesthesia has been used successfully in patients with ventriculo-peritoneal (VP) shunts and high spinal block has not been previouslyreported in the literature in this population. We describe a 74-year-oldpatient with normal pressure hydrocephalus (NPH) and a functioning VPshunt who presented for transurethral resection of a bladder tumor. Thepatient was obese (body mass index, 45 kg/m2) with a potentially difficultairway. Without sedative premedication, a low dose spinal anesthetic wasadministered with hyperbaric bupivacaine (10mg) and fentanyl (10 mcg).The patient suffered immediate respiratory arrest, followed by loss ofconsciousness, bradycardia and hypotension consistent with a high spinalblock. These adverse effects reversed within 4 hours and the patient wasdischarged with no sequelae. A possible explanation for this un-anticipated high spinal block in the context of NPH and a VP shuntincludes an increased gradient of cephalad flow of cerebrospinal fluid(CSF) due to a persisting compensatory increase in CSF reabsorptionfrom NPH as well as CSF flow through the shunt. Our case demonstratesthe need to consider the potential for high spinal block in in a patient withNPH and a VP shunt.[SNACC-109] Anesthesia Management for an Adult Patient WithMethylmalonic Aciduria Undergoing Complex Spinal SurgeryAl-Tamimi M, Krovvidi H, Ellahee P, Russo A. Queen Elizabeth Hos-pital Birmingham, Birmingham, United kingdom.Long-term survival of patients with methylmalonic aciduria (MMA) toadulthood has significantly improved nowadays. However, this hasbrought new challenges in anaesthesia management of these patients. Wereport a case of MMA with multiple complications who was successfullyoperated for complex cervical spine surgery in 2 different positions.A 33-year-old male with MMA, metabolic stroke at the age of 8, dys-tonia, contractures, degenerative spinal cord compression and myelo-malacia was admitted for elective cervical spine surgery. Preoperativeinvestigations were satisfactory. Intravenous 10% dextrose with potas-sium was started during fasting period to prevent metabolic acidosis. OnJ Neurosurg Anesthesiol  Volume 29, Number 4, October 2017 AbstractsCopyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. www.jnsa.com | 557Copyright r 2017 Wolters Kluwer Health, Inc. All rights reserved.

Pupillary pain index correlates with postoperative pain scores in neurosurgical patients

Ferreira, A.

Vide, Sergio

Correia, Rui P.

Nunes, Catarina S.

Amorim, Pedro P.

Bloom, Marc

University of Miami: Scholarship@Miami

Assessment of the opioid effect on the pupillary pain index

https://repositorioaberto.uab.pt/bitstream/10400.2/7532/1/JNA_2017_p556_p557.pdf

Pupillary pain index correlates with postoperative pain scores in neurosurgical patients

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University of Miami: Scholarship@Miami