Monitoring of the intraoperative analgesia by pupillometry during laparoscopic splenectomy for splenic hydatid cyst

Abstract

Echinococcosis causes a hydatid cyst, a worldwide disease. Human beings are intermediate hosts, but dogs complete the life cycle of the cestode. The most common presentation sites are the liver and lungs. We present an unusual case of a primary splenic hydatid cyst. Open splenectomy has traditionally been the treatment of choice for splenic hydatid cysts. In recent years, minimally invasive laparoscopic surgery has been used in appropriate cases. A healthy 48-year-old woman was scheduled for laparoscopic splenectomy. We controlled the intraoperative analgesia using pupillometry. We used it as a method to evaluate the depth of analgesia and to guide opioid administration based on the pupillary dilation reflex. This is regulated by the autonomous sympathetic system. It appears to be more sensitive and reliable than using simple variations in heart rate and blood pressure. It is an easy and safe to use method that might allow a reduction in postoperative analgesic requirements.

Keywords: Echinococcus; Hydatid cyst; Pupillometry; Remifentanil; Splenectomy; TIVA.