Significance of pupillary diameter variation in assessment of postoperative pain / 临床麻醉学杂志

Objective To observe the reactivity of pupillary diameter variation responding to numerical rating scale on postoperative pain to explore the accuracy of pupillary diameter variation for pain assessment.Methods Eighty patients after selected surgery (male 43 cases,female 37 cases,aged 24-79 years,ASA gradeⅠorⅡ)were included for the trial.After endotracheal extubation and on arri-val in the post-anaesthesia care unit (PACU),the levels of pain on numerical rating scale (NRS)were rated and recorded subsequently.If NRS was within 0-3,no analgesic was administered and 50 μg fentanyl was administrated after 5 min if NRS rated in 4-10.The pupillary diameter (PD),systolic blood pressure (SBP)and heart rate (HR)were recorded every minute during 20 minute after first NRS evaluation,the corresponding maximum variation of above index were calculated simultaneously in 10 minutes with NRS 0-3,after 5 minutes with NRS 0-3 to 4-10,after 5 minutes with NRS 4-10 to 0-3,in 10 minutes with NRS 4-10 which were marked respectively with ΔPD,ΔSBP and ΔHR.With the variation of NRS as a criterion,the reactivity of ΔHR,ΔSBP and ΔPD responding to NRS varia-tion were assessed by analysing the receiver operating characteristic curve (ROC),the area under the receiver operating characteristic curve (AUC)was calculated.Results The patients' ROC value ofΔHR,ΔSBP and ΔPD responding to NRS variation were AUCΔPD 0.904 (95% CI 0.822-0.987 ), AUCΔSBP 0.65 1(95%CI 0.5 10-0.781)and AUCΔHR 0.588(95%CI 0.444-0.733)respectively.Value of AUCΔPD was larger than that of AUCΔSBP and AUCΔHR respectively (P < 0.05 ).Importantly, operating characteristic curve (ROC)analysis showed that the diagnostic cutoff value of ΔPD was 41.3% with a sensitivity of 80.0% and a specificity of 93.5% and the diagnostic cutoff value of ΔSBP was 10.3% with a sensitivity of 62.4% and a specificity of 71.5%.Conclusion This study demon-strated that the accuracy of ΔPD was higher than ΔSBP and ΔHR responding to pain/analgesia evalu-ation.ΔPD was a valuable index for assessment of postoperative pain.

Effects of Non-steroidal Anti-inflammatory Drug on Anterior Uveitis

To evaluate effects of the topical administration of non-steroidal antiinflammatory drug on anterior uveitis, suprofen eye drop was instilled into the left eye of 10 pigmented rabbits and then experimental anterior uveitis was induced by injecting 750 mocro gram/kg endotoxin of Shigella flexneri serotype 1A into their peritoneal cavities. The pupillary diameters were measured, and cell and flare gradings were recorded in 20 eyes of 10 rabbits for one week at an interval of 12 hours for the first day and then daily. Differences between the treatment and control groups were investigated. All the above parameters showed greatest changes at 12 or 24 hours after the injection of endotoxin and became normal by one week. The treatment and the control groups demonstrated statistically significant difference at 12 hours, day 1, and day 2 as for pupillary diameter and at day 1 and day 2 as for cell and at 12 hours and day 1 as for flare. Thus, it is concluded that prostaglandin plays a role in miosis and the appearance of inflammatory cells and flare in anterior uveitis and the topical administration of non-steroidal anti-inflammatory drug can alleviate signs of anterior uveitis. The specific relationship between leucotriene B4 and polymorphonuclear leucocytes influx was not demonstrated.

Non-steroidal anti-inflammatory drug and endotoxin induced uveitis

Suprofen eye drop was instilled into one eye of 10 pigmented rabbits and then anterior uveitis was induced by intraperitoneal injection of endotoxin of Shigella flexneri serotype 1A to evaluate the effects of non-steroidal anti-inflammatory drug on endotoxin induced uveitis. The pupillary diameters were measured, and aqueous cell and flare gradings were recorded in 20 eyes of 10 rabbits for one week at an interval of 12 hours for the first 24 hours and then every 24 hours for a week. A difference between the treated and control groups were investigated. All the above parameters showed greatest changes at 12 or 24 hours after injection and became normal by one week. The two groups demonstrated statistically significant difference at 12 hours, day 1 and day 2 as for pupillary diameter, at day 1 and day 2 as for cell and at 12 hours and day 1 as for flare. Thus, it can be concluded that prostaglandins play a role in miosis, in the appearance of inflammatory cells and flare in endotoxin induced uveitis and the topical administration of non-steroidal anti-inflammatory drug can alleviate signs of anterior uveitis. Specific relationship between leukotriene B4 and aqueous cell was not demonstrated.