Relationship between pre‐incision Pupillary Pain Index and post‐incision heart rate and pupillary diameter variation in children

• Published in: Pediatric anesthesia 2021-10, Vol.31 (10), p.1121-1128
• Main Authors: Sabourdin, Nada, Del Bove, Loïc, Louvet, Nicolas, Luzon‐Chetrit, Sarah, Tavernier, Benoît, Constant, Isabelle, Vutskits, Laszlo
• Format: Article
• Language: English
• Subjects: anesthesia; General anesthesia; Heart rate; Life Sciences; monitoring; Pain; pediatric; pupil
• ISSN: 1155-5645; 1460-9592
• DOI: 10.1111/pan.14253

Background The Pupillary Pain Index is a recent pupillometric index designed to assess the level of analgesia under general anesthesia in children and adults. If analgesia is inadequate, acute nociceptive stimuli such as skin incision may induce significant hemodynamic disturbances. Aims Our aim was to investigate the potential relationship between pre‐incision Pupillary Pain Index and heart rate increase following skin incision in children. Methods This was a prospective, non‐randomized, registered pilot study. We included children undergoing surgery under general anesthesia. Pupillary Pain Index was assessed 2 min before skin incision. Then, heart rate maximal variation (ΔHR) and pupillary diameter maximal variation (ΔPD) in the minute following incision were recorded. Spearman coefficient was calculated to characterize the relationship between Pupillary Pain Index and ΔHR or ΔPD. Using receiver operating characteristic curve analysis, we also studied the predictive value of pre‐incision Pupillary Pain Index for heart rate and pupillary diameter reactivity. Results 53 patients were included (10 ± 4 years, 40 ± 19 kg). There was a modest correlation between pre‐incision Pupillary Pain Index and ΔHR (Spearman rs = 0.35 [0.05–0.57], p = .011), and between pre‐incision Pupillary Pain Index and ΔPD (Spearman rs = 0.54 [0.33–0.71], p