Effect of the using a pupillometer on recovery and early cognitive functions in anesthesia management for endoscopic retrograde cholangiopancreaticography in geriatric patients

Effect of the using pupillometer in anesthesia management

Authors

Keywords:

geriatric anesthesia, endoscopic retrograde cholangiopancreatography, pupilometer, mini-mental test, post-operative cognitive dysfunction

Abstract

Background/Aim: Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive procedure used for the diagnosis and treatment of pancreaticobiliary pathologies. Because it is an invasive procedure that is difficult to tolerate by the patient and takes a long time, it is preferable to use it under deep patient sedation and even under general anesthesia in some cases. This study aimed to evaluate the effects of using a pupillometer versus the Ramsey sedation scale (RSS) during anesthesia management for ERCP on recovery and return of cognitive functions in the geriatric patient population.

Methods: A mini-mental test was applied to evaluate the pre-operative cognitive functions of the cases before the intervention. The included patients were divided into groups using the sealed-envelope method. Management of the depth of anesthesia was evaluated by Ramsey sedation scale; in group R and was evaluated by pupillometer in group P. The infusion dose of dexmedetomidine was changed to 0.1 µg/kg/h according to the results of the evaluation.

Results: Sixty cases were included in the study. No difference between the groups in terms of age (P=0.246), gender (P=0.797), American Society of Anesthesiologists (ASA) score (P=0.197), comorbidity (P=0.748), anesthesia duration (P=0.397), midazolam doses (P=0.561), propofol doses (P=0.677), and intra-operative hemodynamic values (P=0.668) were found. Intra-operative dexmedetomidine dose was statistically significantly lower (P=0.004), and recovery was faster in group P (P<0.001). While no differences between the groups in the pre-operative mini-mental test scores (P=0.140) were found, the post-operative scores were statistically significantly lower in group R (P=0.025).

Conclusion: In this study, it was observed that the pupillometer led to a reduction in the use of dexmedetomidine and cognitive functions were better during the post-operative recovery period. As a result, depth of anesthesia can be monitored with a pupillometer. Although the use of pupillometer in endoscopic interventions in the geriatric patient group does not make a hemodynamic difference when compared with the RSS, the pupillometer leads to accelerated recovery from anesthesia, improvement in the return of cognitive functions, and reduction in drug consumption.

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References

Krugliak P, Ziff B, Rusabrov Y, Rosenthal A, Fich A, Gurman GM. Propofol versus midazolam for conscious sedation guided by processed EEG during endoscopic retrograde cholangiopancreatography: a prospective, randomized, double-blind study. Endoscopy. 2000;32(9):677–82. DOI: https://doi.org/10.1055/s-2000-9021

Riphaus A, Stergiou N, Wehrmann T. Sedation with propofol for routine ERCP in high-risk octogenarians: a randomized, controlled study. Am J Gastroenterol. 2005;100(9):1957–63. DOI: https://doi.org/10.1111/j.1572-0241.2005.41672.x

Seifert H, Schmitt TH, Gultekin T, Caspary W F, Wehrmann T. Sedation with propofol plus midazolam versus propofol alone for interventional endoscopic procedures: a prospective, randomized study. Aliment Pharmacol Ther. 2000;14(9):1207–14. DOI: https://doi.org/10.1046/j.1365-2036.2000.00787.x

Hillier SC. Monitored anesthesia care. In: Barash PG, Cullen BF, Stoelting RK (Eds.). Clinical anesthesia. 3rd ed. Philadelphia: Lippincott-Raven; 1997:1159-71

Stanski DR. Monitoring depth of anesthesia. In: Miller RD (ed). Anesthesia. New York: Churchill Livingstone Inc, 2000:1087-116.

Carrasco G. Instruments for monitoring intensive vare unit sedation. Crit Care. 2000;4(4):217-25. DOI: https://doi.org/10.1186/cc697

Sabourdin N, Barrois J, Louvet N, Rigouzzo A, Guye ML, Dadure C, et al. Pupillometryguided intraoperative remifentanil administration versus standard practice influences opioid use: a randomized study. Anesthesiology. 2017;127(2):284–92. DOI: https://doi.org/10.1097/ALN.0000000000001705

Funcke S, Sauerlaender S, Pinnschmidt HO, Saugel B, Bremer K, Reuter DA, et al. Validation of innovative techniques for monitoring nociception during general anesthesia: a clinical study using tetanic and intracutaneous electrical stimulation. Anesthesiology. 2017;127(2):272–83. DOI: https://doi.org/10.1097/ALN.0000000000001670

Larson MD Behrends M. Portable Infrared Pupillometry. Anesthesia & Analgesia. 2015;120(6):1242-53. DOI: https://doi.org/10.1213/ANE.0000000000000314

Yue-Hua L, Feng Q, Jian-Ping G, Yu-Xuan Y. Endoscopic retrograde cholangiopancreatography in the elderly: Non-sedation or general endotracheal anesthesia? Asian J Surg. 2022;45(9):1762. DOI: https://doi.org/10.1016/j.asjsur.2022.03.030

Demiraran Y, Korkut E, Tamer A, Yorulmaz I, Kocaman B, Sezen G, et al. The comparison of dexmedetomidine and midazolam used for sedation of patients during upper endoscopy: A prospective, randomized study. Can J Gastroenterol. 2007;21(1):25-9. DOI: https://doi.org/10.1155/2007/350279

Wehrmann T, Kokabpick S, Lembcke B, Caspary WF, Seifert H. Efficacy and safety of intravenous propofol sedation during routine ERCP: a prospective, controlled study. Gastrointestinal Endoscopy. 1999;49(6):677-83. DOI: https://doi.org/10.1016/S0016-5107(99)70281-6

Paspatis GA, Chainaki I, Manolaraki MM, Vardas E, Theodoropoulou A, Tribonias G, et al. Efficacy of bispectral index monitoring as an adjunct to propofol deep sedation for ERCP: a randomized controlled trial. Endoscopy. 2009;41(12):1046–51. DOI: https://doi.org/10.1055/s-0029-1215342

Liu SS. Effects of bispectral index monitoring on ambulatory anesthesia: a meta-analysis of randomized controlled trials and a cost analysis. Anesthesiology. 2004;101(2):311-5. DOI: https://doi.org/10.1097/00000542-200408000-00010

Bauer M, Wilhelm W, Kraemer T, Kreuer S, Brandt A, Adams HA, et al. Impact of bispectral index monitoring on stress response and propofol consumption in patients undergoing coronary artery bypass surgery. Anesthesiology. 2004;101(5):1096-104. DOI: https://doi.org/10.1097/00000542-200411000-00008

Constant I, Sabourdin N. Monitoring depth of anesthesia: From consciousness to nociception. A window on subcortical brain activity. Paediatr Anaesth. 2015;25(1):73–82 DOI: https://doi.org/10.1111/pan.12586

Chapman CR, Oka S, Bradshaw DH, Jacobson RC, Donaldson GW. Phasic pupil dilation response to noxious stimulation in normal volunteers: Relationship to brain evoked potentials and pain report. Psychophysiology. 1999;36(1):44–52. DOI: https://doi.org/10.1017/S0048577299970373

Larson MD, Kurz A, Sessler DI, Dechert M, Bjorksten AR, Tayefeh F. Alfentanil blocks reflex pupillary dilation in response to noxious stimulation but does not diminish the light reflex. Anesthesıology. 1997;87(4):849–55. DOI: https://doi.org/10.1097/00000542-199710000-00019

Barvais L, Engelman E, Eba JM, Coussaert E, Cantraine F, Kenny GN. Effect site concentrations of remifentanil and pupil response to noxious stimulation. Br J Anaesth. 2003;91(3):347–52. DOI: https://doi.org/10.1093/bja/aeg178

Aissou M, Snauwaert A, Dupuis C, Atchabahian A, Aubrun F, Beaussier M. Objective assessment of the immediate Postoperative analgesia using pupillary reflex measurement: A prospective and observational study. Anesthesıology. 2012;116(5):1006–12. DOI: https://doi.org/10.1097/ALN.0b013e318251d1fb

Arain SR, Ebert TJ. The efficacy, side effects, and recovery characteristics of dexmedetomidine versus propofol when used for intraoperative sedation. Anesth Analg. 2002;95(2):461-6. DOI: https://doi.org/10.1213/00000539-200208000-00042

Ceylan G, Yavaşcaoğlu B, Korfali G, Kaya F, Başağan Moğol E, Türker G. ERCP İçin Bilinçli Sedasyon Uygulamasında Propofol ile Deksmedetomidinin Hemodinami ve Kognitif Fonksiyonlara Etkisinin Karşılaştırılması. Uludağ Üniversitesi Tıp Fakültesi Dergisi. 2010;36(3):103-10.

Recart A, Gasanova I, White PF, Thomas T, Ogunnaike B, Hamza M, et al. The effect of cerebral monitoring on recovery after general anesthesia: a comparison of the auditory evoked potential and bispectral index devices with standard clinical practice. Anesth Analg. 2003;97(6):1667-74. DOI: https://doi.org/10.1213/01.ANE.0000087041.63034.8C

Lewis SR, Pritchard MW, Fawcett LJ, Punjasawadwong Y. Bispectral index for improving intraoperative awareness and early postoperative recovery in adults. Cochrane Database Syst Rev. 2019;9:CD003843. DOI: https://doi.org/10.1002/14651858.CD003843.pub4

Chiang MH, Wu SC, Hsu SW, Chin JC. Bispectral Index and non-Bispectral Index anesthetic protocols on postoperative recovery outcomes. Minerva Anestesiol. 2018;84(2):216-28. DOI: https://doi.org/10.23736/S0375-9393.17.12033-X

Gruenewald M, Harju J, Preckel B, Molnár Z, Yli-Hankala A, Rosskopf F, et al. Comparison of adequacy of anaesthesia monitoring with standard clinical practice monitoring during routine general anaesthesia: An international, multicentre, singleblinded randomised controlled trial. Eur J Anaesthesiol. 2021;38(1):73-81. DOI: https://doi.org/10.1097/EJA.0000000000001357

Yilmaz R, Topal A, Arican S, Hacibeyoglu G, Turk S. The effects of ‘Adequacy of Anesthesia’ monitorization in general anesthesia on hemodynamics, recovery, and the cost of anesthetic drugs. Kuwait Medical Journal. 2022;54(2):208-14

İnan G, Emmez G, Pampal HK, Ozkose Satirlar Z. The Effect of Smartpilot View, A New Decision Support System on Recovery and Anesthetic Consumption in Spinal Surgery: A Retrospective Study. JARSS. 2021;29(4):226-32. DOI: https://doi.org/10.5222/jarss.2021.66588

Cirillo V, Zito Marinosci G, De Robertis E, Iacono C, Romano GM, Desantis O, et al. Navigator and SmartPilot View are helpful in guiding anesthesia and reducing anesthetic drug dosing. Minerva Anestesiol. 2015;81(11):1163-9.

Mahanna-Gabrielli E, Schenning KJ, Eriksson LI, Jeffrey NB, Clinton BW, Deborah JC, et al. State of the clinical science of perioperative brain health. Br J Anaesth. 2019;123(4):464-78. DOI: https://doi.org/10.1016/j.bja.2019.09.014

Borson S, Scanlan J, Brush M, Vitaliano P, Dokmak A. The minicog: a cognitive ‘vital signs’ measure for dementia screening in multi-lingual elderly. Int J Geriatr Psychiatry. 2000;15(11):1021-7. DOI: https://doi.org/10.1002/1099-1166(200011)15:11<1021::AID-GPS234>3.0.CO;2-6

Ansaloni L, Catena F, Chattat R, Fortuna D, Franceschi C, Mascitti P, et al. Risk factors and incidence of postoperative delirium in elderly patients after elective and emergency surgery. Br J Surg 2010;97(2):273-80. DOI: https://doi.org/10.1002/bjs.6843

Rudolph JL, Jones RN, Levkoff SE, Rockett C, Inouye SK, Sellke FW, et al. Derivation and validation of a preoperative prediction rule for delirium after cardiac surgery. Circulation. 2009;119(2):229-36. DOI: https://doi.org/10.1161/CIRCULATIONAHA.108.795260

Zhang Y, Shan GJ, Zhang YX, Cao SJ, Zhu SN, Li HJ, et al. Propofol compared with sevoflurane general anaesthesia is associated with decreased delayed neurocognitive recovery in older adults. British Journal of Anaesthesia. 2018:121(3);595-604. DOI: https://doi.org/10.1016/j.bja.2018.05.059

Christopher LW, Wesley HBS, Jeffrey MR, Srinivasa NR. Postoperative cognitive function as an outcome of regional anesthesia and analgesia. Reg Anesth and Pain Med. 2004;29(3):257-68. DOI: https://doi.org/10.1016/j.rapm.2003.11.007

Gao L, Taha R, Gauvin D, Othmen LB, Wang Y, Blaise G. Postoperative cognitive dysfunction after cardiac surgery. Chest. 2005;128(5):3664-70. DOI: https://doi.org/10.1378/chest.128.5.3664

Ahlgren E, Lundquis A, Nordlund A, Aren C, Rutberg H. Neurocognitive impairment and driving performance after coronary artery bypass surgery. Eur J Cardiothorac Surg. 2000;23(3):334-40. DOI: https://doi.org/10.1016/s1010-7940(02)00807-2

Janssen TL, Alberts AR, Hooft L, Mattace-Raso F, Mosk CA, van der Laan L. Prevention of postoperative delirium in elderly patients planned for elective surgery: systematic review and meta-analysis. Clin Interv Aging. 2019;19(14):1095-117. DOI: https://doi.org/10.2147/CIA.S201323

Zhang H, Wu Z, Zhao X, Qiao Y. Role of dexmedetomidine in reducing the incidence of postoperative cognitive dysfunction caused by sevoflurane inhalation anesthesia in elderly patients with esophageal carcinoma. J Cancer Res Ther. 2018;14(7):1497-502. DOI: https://doi.org/10.4103/jcrt.JCRT_164_18

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Published

2023-01-16

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Research Article

How to Cite

1.
Yılmaz R, Büyükbezirci G, Arıcan Şule, Özkan Kaya A, Asıl M. Effect of the using a pupillometer on recovery and early cognitive functions in anesthesia management for endoscopic retrograde cholangiopancreaticography in geriatric patients : Effect of the using pupillometer in anesthesia management. J Surg Med [Internet]. 2023 Jan. 16 [cited 2024 Apr. 19];7(1):31-4. Available from: https://jsurgmed.com/article/view/7501