The Influence of Opioids on Pupil Initial Diameter and Pupillary Dilation Velocity in ICU Patients.

IF 1.9 4区 医学 Q2 ANESTHESIOLOGY
Valdemar Oskar Ingemann Sørensen, Stine Uhrenholt, Jannik Stokholm, Thomas Christensen, Morten Heiberg Bestle
{"title":"The Influence of Opioids on Pupil Initial Diameter and Pupillary Dilation Velocity in ICU Patients.","authors":"Valdemar Oskar Ingemann Sørensen, Stine Uhrenholt, Jannik Stokholm, Thomas Christensen, Morten Heiberg Bestle","doi":"10.1111/aas.70080","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Pupillary light reflex assessment is a promising modality for assessing autonomic nervous system status, given that it is fast, noninvasive, and provides quantitative results. Opioid therapy influences the pupil and is frequently used in the intensive care unit (ICU). We investigated the effect of opioids on pupillary size and dilation velocity in the pupillary light reflex in critically ill patients.</p><p><strong>Methods: </strong>This is a sub-study on 55 patients from a prospective observational study acutely admitted to an ICU. All patients had daily blood samples and pupillary light reflex measurements. Blood samples were analyzed for opioids using mass spectrometry. Linear mixed models were used to estimate the possible association for each detected opioid to pupillary size and dilation velocity in the pupillary light reflex.</p><p><strong>Results: </strong>The pupil size before a light stimulus was closely associated to the dilation velocity after the light stimulus. The increase in the dilation velocity was 0.2 mm/s per 1 mm increase in pupil diameter before the light stimulus, 95% confidence interval [0.2-0.3], p < 0.001. Presence of fentanyl was associated with a smaller pupil size and a slower pupillary dilation velocity.</p><p><strong>Conclusions: </strong>The presence of fentanyl in blood samples from a mixed ICU population is associated with a slower pupillary dilation velocity in a concentration-dependent matter.</p><p><strong>Editorial comment: </strong>This study assesses the relation of observed opioid levels and light reflex pupillary size speed of change in an ICU cohort where there can be multiple classes of drugs present which influence autonomic nerve system function. Findings for different opioids, though most specifically fentanyl, show that opioid plasma concentrations have clear association with slower pupillary dilation velocity with light reflex response.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 6","pages":"e70080"},"PeriodicalIF":1.9000,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12185176/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Acta Anaesthesiologica Scandinavica","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/aas.70080","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Background: Pupillary light reflex assessment is a promising modality for assessing autonomic nervous system status, given that it is fast, noninvasive, and provides quantitative results. Opioid therapy influences the pupil and is frequently used in the intensive care unit (ICU). We investigated the effect of opioids on pupillary size and dilation velocity in the pupillary light reflex in critically ill patients.

Methods: This is a sub-study on 55 patients from a prospective observational study acutely admitted to an ICU. All patients had daily blood samples and pupillary light reflex measurements. Blood samples were analyzed for opioids using mass spectrometry. Linear mixed models were used to estimate the possible association for each detected opioid to pupillary size and dilation velocity in the pupillary light reflex.

Results: The pupil size before a light stimulus was closely associated to the dilation velocity after the light stimulus. The increase in the dilation velocity was 0.2 mm/s per 1 mm increase in pupil diameter before the light stimulus, 95% confidence interval [0.2-0.3], p < 0.001. Presence of fentanyl was associated with a smaller pupil size and a slower pupillary dilation velocity.

Conclusions: The presence of fentanyl in blood samples from a mixed ICU population is associated with a slower pupillary dilation velocity in a concentration-dependent matter.

Editorial comment: This study assesses the relation of observed opioid levels and light reflex pupillary size speed of change in an ICU cohort where there can be multiple classes of drugs present which influence autonomic nerve system function. Findings for different opioids, though most specifically fentanyl, show that opioid plasma concentrations have clear association with slower pupillary dilation velocity with light reflex response.

阿片类药物对ICU患者瞳孔初始直径和瞳孔扩张速度的影响。
背景:瞳孔光反射评估是评估自主神经系统状态的一种很有前途的方式,因为它快速,无创,并提供定量结果。阿片类药物治疗影响瞳孔,经常用于重症监护病房(ICU)。我们研究了阿片类药物对危重患者瞳孔大小和瞳孔光反射扩张速度的影响。方法:这是一项对55例急性入住ICU的前瞻性观察性研究的亚研究。所有患者均每日抽血并进行瞳孔光反射测量。血液样本用质谱法分析阿片类药物。使用线性混合模型估计每种检测到的阿片类药物与瞳孔大小和瞳孔光反射扩张速度的可能关联。结果:光刺激前瞳孔大小与光刺激后瞳孔扩张速度密切相关。光刺激前瞳孔直径每增加1mm,扩张速度增加0.2 mm/s, 95%可信区间[0.2-0.3],p结论:混合ICU人群血液样本中芬太尼的存在与瞳孔扩张速度减慢呈浓度依赖性。编者按:本研究评估了在ICU队列中观察到的阿片类药物水平与瞳孔光反射大小变化速度的关系,其中可能存在多种影响自主神经系统功能的药物。不同阿片类药物的研究结果,尤其是芬太尼,表明阿片类药物血浆浓度与瞳孔扩张速度减慢和光反射反应明显相关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
4.30
自引率
9.50%
发文量
157
审稿时长
3-8 weeks
期刊介绍: Acta Anaesthesiologica Scandinavica publishes papers on original work in the fields of anaesthesiology, intensive care, pain, emergency medicine, and subjects related to their basic sciences, on condition that they are contributed exclusively to this Journal. Case reports and short communications may be considered for publication if of particular interest; also letters to the Editor, especially if related to already published material. The editorial board is free to discuss the publication of reviews on current topics, the choice of which, however, is the prerogative of the board. Every effort will be made by the Editors and selected experts to expedite a critical review of manuscripts in order to ensure rapid publication of papers of a high scientific standard.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信