• Céline Riffard, Truong Quoc Viêt, François-Pierrick Desgranges, Lionel Bouvet, Bernard Allaouchiche, Adrienne Stewart, and Dominique Chassard.
• Department of Anaesthesia and Intensive Care Medicine, Femme-Mère-Enfant Teaching Hospital, hospices civils de Lyon, Claude-Bernard Lyon 1 University, 59, boulevard Pinel, 69677 Bron, France.
• Anaesth Crit Care Pain Med. 2018 Jun 1; 37 (3): 233-238.

IntroductionThe balance between the sympathetic and parasympathetic systems could be used to predict the onset of hypotension following spinal anaesthesia. The autonomic innervation of the pupil may reflect this balance. The aim of this study was to evaluate the ability of pupillometry to predict the risk of hypotension after spinal anaesthesia for caesarean section.MethodsTwo hundred patients receiving spinal anaesthesia for caesarean section were recruited. Changes in pupillary diameter, pupillary reaction latency, pupil constriction velocity and maximum and minimum pupillary diameters were measured with a pupillometer (Neurolight®, IDMed) prior to induction of spinal anaesthesia with 10mg bupivacaine and fentanyl 30μg. Hypotension was defined as a systolic blood pressure drop of > 20% compared with the baseline value.ResultsA total of 141 patients (70%) presented at least one episode of hypotension. Pupillary reaction latency can poorly predict hypotension and severe hypotension after spinal anaesthesia. The areas under the receiver-operating characteristic curves were 0.654 (95% confidence interval: 0.584-0.720, P=0.0001) and 0.633 (95% confidence interval: 0.562-0.700, P=0.004) for optimal threshold values of 223 and 231ms, respectively. In multivariate analysis, a baseline systolic blood pressure > 130mmHg (odds ratio: 1.98, P=0.04) and a PRL > 223ms (odds ratio: 3.42, P=0.0002) were independently associated with the risk of spinal anaesthesia-related hypotension.ConclusionFollowing spinal anaesthesia in patients undergoing caesarean section, though the predictive capacity pupillary reaction latency for the onset of hypotension and severe hypotension is poor, it is nevertheless the strongest predictor of hypotension identified in our study.Copyright © 2018 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

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