Journal of Clinical Monitoring and Computing

, Volume 31, Issue 2, pp 291–296 | Cite as

The effects of anesthetic agents on pupillary function during general anesthesia using the automated infrared quantitative pupillometer

  • Kazuhiro ShirozuEmail author
  • Hidekazu Setoguchi
  • Kentaro Tokuda
  • Yuji Karashima
  • Mizuko Ikeda
  • Makoto Kubo
  • Katsuya Nakamura
  • Sumio Hoka
Original Research


Pupil reactivity can be used to evaluate central nervous system function and can be measured using a quantitative pupillometer. However, whether anesthetic agents affect the accuracy of the technique remains unclear. We examined the effects of anesthetic agents on pupillary reactivity. Thirty-five patients scheduled for breast or thyroid surgery were enrolled in the study. Patients were divided into four groups based on the technique used to maintain anesthesia: a sevoflurane–remifentanil (SEV/REM) group, a sevoflurane (SEV) group, a desflurane–remifentanil (DES/REM) group, and a propofol–remifentanil (PRO/REM) group. We measured maximum resting pupil size (MAX), reduction pupil size ratio (%CH), latency duration (LAT) and neurological pupil index (NPi). A marked reduction in MAX and %CH compared with baseline was observed in all groups, but LAT was unchanged during surgery. NPi reduced within the first hour of surgery in the SEV/REM, SEV, and DES/REM groups, but was not significantly different in the PRO/REM group. Compared with the PRO/REM group, mean %CH and NPi in patients anesthetized with SEV/REM, SEV or DES/REM were markedly lower at 1 h after surgery had commenced. There was no correlation between NPi and bispectral index. Fentanyl given alone decreased pupil size and %CH in light reflex, but did not change the NPi. NPi was decreased by inhalational anesthesia not but intravenous anesthesia. The difference in pupil reactivity between inhalational anesthetic and propofol may indicate differences in the alteration of midbrain reflexs in patients under inhalational or intravenous anesthesia.


NPi Pupil reactivity Quantitative pupillometer 



Supported by departmental funding only.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media Dordrecht 2016

Authors and Affiliations

  • Kazuhiro Shirozu
    • 1
    Email author
  • Hidekazu Setoguchi
    • 1
  • Kentaro Tokuda
    • 2
  • Yuji Karashima
    • 3
  • Mizuko Ikeda
    • 1
  • Makoto Kubo
    • 4
  • Katsuya Nakamura
    • 4
  • Sumio Hoka
    • 3
  1. 1.Operating RoomsKyushu University HospitalFukuokaJapan
  2. 2.Intensive Care UnitKyushu University HospitalFukuokaJapan
  3. 3.Department of Anesthesiology and Critical Care MedicineKyushu University Graduate School of Medical SciencesFukuokaJapan
  4. 4.Department of Surgery and OncologyKyushu University HospitalFukuokaJapan

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