Amorim, Pedro

Antunes, P.

Cabral, Tiago

Correia, Rui P.

Nunes, Catarina S.

Teixeira, J.

Vide, Sérgio

English

Repositório Aberto da Universidade Aberta

However, the incidence of postoperative side effects like sedation, dizziness andvisual blurring were more in patients who received pregabalin 300mg.[SNACC-55] Intrapatient Variability of the Pupillary Pain Indexto RemifentanilVide S*, Correia R†, Cabral T‡, Antunes P§, Teixeira J∥, Nunes C¶,Amorim P†. *Hospital Pedro Hispano, Matosinhos. †Centro HospitalarDo Porto. ¶Universidade Aberta, Porto. ‡Hospital Do Divino EspíritoSanto, Ponta Delgada. §Centro Hospitalar Tondela Viseu, Viseu. ∥CentroHospitalar De Setubal, Setubal, Portugal.Background: Current PKPD models used by the TCI systems integrateinformation from covariate factors such as age, weight, height, sex, todecrease variability in the expected response. In our study, we evaluated ifPupillary Pain Index (PPI) could accompany the changes within the samesubjects, produced by shifting the target concentrations of Remifentanilthrough a TCI system with the Minto Model.Methods: This is an observational prospective study, where 8 patientsundergoing neurosurgical procedures with general anesthesia wereincluded. Propofol and remifentanil were administered using TCI system.After loss of consciousness, effect site concentration of remifentanil wasincreased until the analgesic level was deemed adequate for intubation.Measurements of the analgesic effect were based on the Pupillary Dila-tion Response determined through pupillometry using AlgiScan and thePPI. The PPI consists in measuring the changes in pupillary dilation inresponse to a continuously increasing electric stimulus discharge, whichthen assigns scores from 1 (when pupillary dilation is <5% despitemaximal tetanic stimulation intensity) to 10 (when pupillary dilation risesabove 13% with the 10mA). Data analysis was done using Friedman teston SPSS version 22 and data are mean±SD or %.Results: Figure 1 shows the PPI trend for each individual across thedifferent measurements with increasing remifentanil. Group analysis ofremifentanil effect-site concentrations and PPI measurements are de-picted in Figure 2. PPI values were significantly different for eachmeasurement (nonparametric 2-way ANOVA, P= 0.003). Remifentaniland propofol estimated concentrations were also different betweenmeasurements (Friedman test, P< 0.001).Conclusions: For each individual, increasing the effect site concentrationsof remifentanil produced an accompanying change in the PPI measure-ment. These results show that PPI has the ability to react to the changesproduced, within the same patient, by setting different effect-site con-centration targets of remifentanil using the Minto Model.Acknowledgements: LAETA-INEGI.[SNACC-56] A Proof of Concept Study to Evaluate the Admin-istration of CN-105 in Participants With Acute SupratentorialIntracerebral Hemorrhage (CATCH Trial)James M*, Laskowitz D*, Worrall B†, Tucker K‡, Swisher C*. *DukeUniversity, Durham. ‡Baptist—Wake Forest University, Winston-Salem,NC. †University of Virginia, Charlottesville, VA.Background: There is an unmet medical need for a pharmacological in-tervention to improve outcomes after acute primary intracerebralhemorrhage (ICH). We developed a novel therapeutic approach based onthe known biological function of endogenous apolipoprotein E (apoE).ApoE is a key mediator of the neuroinflammatory response and modifiesrecovery from a variety of acute and chronic brain injuries. Un-fortunately, intact apoE holoprotein does not cross the blood-brainbarrier (BBB) and cannot be administered as a neurotherapeutic. How-ever, we have previously demonstrated that smaller apoE-mimetic pep-tides cross the BBB and effectively downregulate neuroinflammatoryresponses in vitro and in vivo. CN-105, our lead clinical candidate, is asmall, 5-amino acid apoE-mimetic peptide that is derived from the re-ceptor-binding region of apoE. CN-105 retains the anti-inflammatoryand neuroprotective effects of intact apoE, was well tolerated in pre-clinical studies, readily crosses the BBB, and demonstrates excellentpharmacokinetic, safety, and tolerability profiles in phase 1 studies.Objectives: Primary: to assess safety of CN-105 administration in primaryICH. Secondary: to evaluate effects of CN-105 administration on 30-daymortality and functional outcomes. Exploratory: to investigate feasibility ofradiographic surrogates of clinical outcomes using perihematomal edemameasurements on day 0, 1, 2, and 5 noncontrast head computed tomographyand 72-hour magnetic resonance imaging, and to investigate feasibility ofusing serial biochemical markers of neuroinflammation and neuronal injuryas a surrogate measures of perihematomal edema and clinical outcome.Methods: This is a multicenter, open-label phase 2a trial of CN-105 inpatients with acute primary supratentorial ICH. A total of 45 male andJ Neurosurg Anesthesiol  Volume 29, Number 4, October 2017 AbstractsCopyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. www.jnsa.com | 527Copyright r 2017 Wolters Kluwer Health, Inc. All rights reserved.

Intrapatient variability of the pupillary pain index to remifentanil

Vide, Sergio

Amorim, Pedro P.

The Repositório Aberto

However, the incidence of postoperative side effects like sedation, dizziness and
visual blurring were more in patients who received pregabalin 300mg.
[SNACC-55] Intrapatient Variability of the Pupillary Pain Index
to Remifentanil
Vide S*, Correia R†, Cabral T‡, Antunes P§, Teixeira J∥, Nunes C¶,
Amorim P†. *Hospital Pedro Hispano, Matosinhos. †Centro Hospitalar
Do Porto. ¶Universidade Aberta, Porto. ‡Hospital Do Divino Espírito
Santo, Ponta Delgada. §Centro Hospitalar Tondela Viseu, Viseu. ∥Centro
Hospitalar De Setubal, Setubal, Portugal.
Background: Current PKPD models used by the TCI systems integrate
information from covariate factors such as age, weight, height, sex, to
decrease variability in the expected response. In our study, we evaluated if
Pupillary Pain Index (PPI) could accompany the changes within the same
subjects, produced by shifting the target concentrations of Remifentanil
through a TCI system with the Minto Model.
Methods: This is an observational prospective study, where 8 patients
undergoing neurosurgical procedures with general anesthesia were
included. Propofol and remifentanil were administered using TCI system.
After loss of consciousness, effect site concentration of remifentanil was
increased until the analgesic level was deemed adequate for intubation.
Measurements of the analgesic effect were based on the Pupillary Dila-
tion Response determined through pupillometry using AlgiScan and the
PPI. The PPI consists in measuring the changes in pupillary dilation in
response to a continuously increasing electric stimulus discharge, which
then assigns scores from 1 (when pupillary dilation is <5% despite
maximal tetanic stimulation intensity) to 10 (when pupillary dilation rises
above 13% with the 10mA). Data analysis was done using Friedman test
on SPSS version 22 and data are mean±SD or %.
Results: Figure 1 shows the PPI trend for each individual across the
different measurements with increasing remifentanil. Group analysis of
remifentanil effect-site concentrations and PPI measurements are de-
picted in Figure 2. PPI values were significantly different for each
measurement (nonparametric 2-way ANOVA, P= 0.003). Remifentanil
and propofol estimated concentrations were also different between
measurements (Friedman test, P< 0.001).
Conclusions: For each individual, increasing the effect site concentrations
of remifentanil produced an accompanying change in the PPI measure-
ment. These results show that PPI has the ability to react to the changes
produced, within the same patient, by setting different effect-site con-
centration targets of remifentanil using the Minto Model.
Acknowledgements: LAETA-INEGI.
[SNACC-56] A Proof of Concept Study to Evaluate the Admin-
istration of CN-105 in Participants With Acute Supratentorial
Intracerebral Hemorrhage (CATCH Trial)
James M*, Laskowitz D*, Worrall B†, Tucker K‡, Swisher C*. *Duke
University, Durham. ‡Baptist—Wake Forest University, Winston-Salem,
NC. †University of Virginia, Charlottesville, VA.
Background: There is an unmet medical need for a pharmacological in-
tervention to improve outcomes after acute primary intracerebral
hemorrhage (ICH). We developed a novel therapeutic approach based on
the known biological function of endogenous apolipoprotein E (apoE).
ApoE is a key mediator of the neuroinflammatory response and modifies
recovery from a variety of acute and chronic brain injuries. Un-
fortunately, intact apoE holoprotein does not cross the blood-brain
barrier (BBB) and cannot be administered as a neurotherapeutic. How-
ever, we have previously demonstrated that smaller apoE-mimetic pep-
tides cross the BBB and effectively downregulate neuroinflammatory
responses in vitro and in vivo. CN-105, our lead clinical candidate, is a
small, 5-amino acid apoE-mimetic peptide that is derived from the re-
ceptor-binding region of apoE. CN-105 retains the anti-inflammatory
and neuroprotective effects of intact apoE, was well tolerated in pre-
clinical studies, readily crosses the BBB, and demonstrates excellent
pharmacokinetic, safety, and tolerability profiles in phase 1 studies.
Objectives: Primary: to assess safety of CN-105 administration in primary
ICH. Secondary: to evaluate effects of CN-105 administration on 30-day
mortality and functional outcomes. Exploratory: to investigate feasibility of
radiographic surrogates of clinical outcomes using perihematomal edema
measurements on day 0, 1, 2, and 5 noncontrast head computed tomography
and 72-hour magnetic resonance imaging, and to investigate feasibility of
using serial biochemical markers of neuroinflammation and neuronal injury
as a surrogate measures of perihematomal edema and clinical outcome.
Methods: This is a multicenter, open-label phase 2a trial of CN-105 in
patients with acute primary supratentorial ICH. A total of 45 male and
J Neurosurg Anesthesiol  Volume 29, Number 4, October 2017 Abstracts
Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. www.jnsa.com | 527
Copyright r 2017 Wolters Kluwer Health, Inc. All rights reserved.


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Intrapatient variability of the pupillary pain index to remifentanil

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