Intraoperative pain monitoring, can you do it in the end?

we know Pain is an unpleasant subjective feeling Therefore, daily when we evaluate the analgesic effect Mainly through the main complaint of the patientBut when the patient is under general anesthesia We usually can only rely on Changes in heart rate and blood pressure Own medication habits Come on analgesicsObviously these two methods Is not a reliable methodHow to understand the perception of pain in patients with general anesthesia And then measure the patient’s analgesia level Is a problem that bothers us (But we have to believe that this is by no means an unsolvable problem)In this article we will introduce a New methods of pain assessmentPupil Pain Index (Pupillometry pain index, PPI)we know Pupil size is controlled by both sympathetic and parasympathetic nerves Sympathetic nerve excitement causes pupil dilation The pupils shrink when the parasympathetic nerve is excitedWhether the body is awake or anesthetized When receiving noxious stimulation Pupils will dilate

And opioids can pass Reduce the inhibition of Edinger-Westphal nuclei Raise the distance between the Edinger-Westphal nucleus and the pupil Tension of the parasympathetic nerve pathway So that the pupils shrink

We know that pain is an unpleasant subjective feeling.

And opioids by inhibiting reducing the Edinger-Westphal nucleus of between improve Edinger-Westphal nucleus and pupil parasympathetic passage tension of tension so that miosis

 

 

Based on the above two points, we can conclude that based on the above two points, we can conclude that the pupil dilation is proportional to the pain stimulus.
The pupil dilation is proportional to the pain stimulus and the opioid dose is inversely proportional to the opioid dose.
inversely So we can so we can be as an indicator of changes in pupil diameter pain monitoring of the pupil diameter changes as an indicator of pain monitoring in 2019 a study published in the "Anesth Analg" found after receiving sevoflurane induction 10min vein A bolus of 10ug/kg of Alfentanil can decrease PPI readings.
The results of this study show that when analgesia levels increase, PPI values ​​decrease A prospective study published in Sci Rep in 2020 divides patients with general anesthesia into two standard groups: the anesthesiologist decides the dosage of Sufen on his own.
Intervention group: adjusts the dosage of Sufen based on PPIThe results found that the intraoperative sufentanil dosage in the intervention group was lower than that in the standard group and there was no significant difference in pain between the two groups after surgery.
This indicates that PPI monitoring can reduce the sufentanil dosageHowever, because the diameter of the pupil is also affected by the ambient light, the traditional pupil measurement method is difficult to accurately measure the pupil diameter (the pupil diameter can be changed when the eyelid is opened)With the development of technology, there are more objective and accurate pupil measuring instruments on the market.
AlgiScan is a portable measuring instrument .
The eyecup part of the front end can eliminate the influence of ambient light on the measurement results.
In addition, the pupil measuring instrument can be very accurate to complete the measurement of pupil size through the camera system, and its measurement accuracy can reach 0.
1mmIn addition, the pupillometer can quantify the change in pupil diameter caused by painful stimulation and finally obtain the pupil pain index.
 Summary Summary sedation, analgesia, muscle relaxation during general anesthesia in the three elements present, sedative and muscle relaxant early already have a more mature means of monitoring and for pain has been the lack of objective and reliable monitoring indicators but we want to truly accurate anesthesia precision must be in pain monitoring and management aspects of management further breakthroughs (important for us to believe this is absolutely achievable) believe that day to solve this problem will be a new milestone in precision anesthesia with lofty ideals, come dry ah! People with lofty ideals, come on! Leave a message here