Midbrain single units correlating with pupil response to light

Intranasal dexmedetomidine with morphine or tramadol: A comparative study of effects on alfaxalone requirements for anesthesia in cats

Background and Aim

Intranasal (IN) sedatives provide a non-invasive route for premedication drug administration. This study compared the cardiorespiratory and sparing effects of IN dexmedetomidine combined with morphine (DM) or tramadol (DT) on alfaxalone requirements for anesthesia induction in cats.

Materials and Methods

Twenty-four cats were randomly assigned to three groups: Dexmedetomidine combined morphine (IN dexmedetomidine 20 μg/kg plus 0.2 mg/kg morphine), DT (IN dexmedetomidine 20 μg/kg plus 1 mg/kg tramadol), or control (no premedication). The intravenous dose of 1% alfaxalone for endotracheal intubation was recorded with sedation scores, cardiorespiratory parameters (heart rate and respiration rate), and side effects.

Results

Both DM and DT were associated with significantly higher sedation scores than baseline, and sedation scores were found to be highest 20 min after premedication. Sedation scores were comparable between DM and DT groups. Side effects, including hypersalivation, vomiting, and pupillary dilation, were observed in the DM and DT groups. The dosage of alfaxalone required in the DM group (1.5 ± 0.3 mg/kg) was comparable to that of the DT group (2.0 ± 0.6 mg/kg, p = 0.0861), and both groups required significantly less alfaxalone than the control group (3.0 ± 0.6 mg/kg; p < 0.01). Heart and respiratory rates were comparable between the DM and DT groups. Duration of anesthesia in the control group (11 ± 4 min) was significantly shorter than in the DM (29 ± 5 min, p = 0.0016) and DT (38 ± 14 min, p < 0.001) groups.

Conclusion

Intranasal administration of DM or DT produces good sedation and offers an alternative, non-invasive route for cats undergoing general anesthesia.

A unified model of the task-evoked pupil response

The pupil dilates and reconstricts following task events. It is popular to model this task-evoked pupil response as a linear transformation of event-locked impulses, whose amplitudes are used as estimates of arousal. We show that this model is incorrect and propose an alternative model based on the physiological finding that a common neural input drives saccades and pupil size. The estimates of arousal from our model agreed with key predictions: Arousal scaled with task difficulty and behavioral performance but was invariant to small differences in trial duration. Moreover, the model offers a unified explanation for a wide range of phenomena: entrainment of pupil size and saccades to task timing, modulation of pupil response amplitude and noise with task difficulty, reaction time-dependent modulation of pupil response timing and amplitude, a constrictory pupil response time-locked to saccades, and task-dependent distortion of this saccade-locked pupil response.

Detection of opioid effect with pupillometry

BACKGROUND

Opioids produce pupillary constriction but their impact on pupillary unrest and the dynamic parameters of the pupillary light reflex have not been characterized. Given the increasing use of portable pupillometers for care of critically ill patients, it is important to distinguish between opioid effects on the pupil versus those that have been reported to arise from traumatic and ischemic brain insults. We undertook this study to determine which pupillary responses are most profoundly and consistently affected by a progressive infusion of remifentanil.

METHODS

We studied the effect of remifentanil on the pupil using two portable infrared pupillometers in 18 volunteers. One pupillometer measured pupillary unrest in ambient light (PUAL) and the other pupillometer measured neurological pupillary index (NPi), constriction velocity (CV), pupil diameter (PD), latency, and % reflex (% reflex) following a transient light flash. Remifentanil was administered at predetermined weight-adjusted rates to raise opioid effect site concentration up to a range known to produce respiratory depression and oxyhemoglobin desaturation, based on a previously published pharmacokinetic model.

RESULTS

PUAL was ablated by remifentanil, declining 94 ± 6% from baseline at the time of maximum drug effect. Other pupillary measurements decreased 50-65% from baseline. NPi was unchanged. At the time of oxyhemoglobin desaturation, deviations in PD, CV, and % reflex were widely scattered, whereas PUAL consistently approached zero.

CONCLUSION

PUAL is a highly specific indicator of central opioid effect. As a non-invasive measure, it may provide useful data to clinicians who prescribe opioids.

Diverse autonomic regulation of pupillary function and the cardiovascular system during alcohol withdrawal

BACKGROUND

Previous research indicated the complexity of autonomic dysfunction during acute alcohol withdrawal. This study aimed to investigate the pupillary light reflex as an indicator of midbrain and brainstem regulatory systems in relation to cardiovascular autonomic function.

METHODS

Thirty male patients were included in the study. They were investigated during acute alcohol withdrawal syndrome and 24h later during clomethiazole treatment and compared to healthy controls. Parameters of pupillary light reflex of both eyes as well as heart rate variability, blood pressure variability and baroreflex sensitivity (BRS) were studied.

RESULTS

We observed significantly reduced sympathetic (small diameter, e.g., left eye: 5.00 in patients vs. 5.91 mm in controls) and vagal modulation (e.g., prolonged latencies, left eye: 0.28 vs. 0.26 ms) regarding both pupils during acute alcohol withdrawal syndrome. Cardiovascular parameters showed reduced vagal modulation (e.g., b-slope of BRS: 7. 57 vs. 13.59 ms/mm Hg) and mixed results for sympathetic influence. After 24h, autonomic dysfunction improved significantly, both for the pupils (e.g., left diameter: 5.38 mm) and the heart (e.g., b-slope of BRS: 9.34 ms/mm Hg). While parameters obtained from the pupil correlated with cardiac autonomic function (e.g, BRS and left diameter: r=0.564) in healthy controls, no such pattern was observed in patients.

CONCLUSION

Results obtained from the pupil during acute alcohol withdrawal do not simply mirror autonomic dysfunction regarding the heart. Pupillary and cardiovascular changes after 24h indicate state dependencies of the results. The findings are discussed with respect to autonomic mechanisms and potentially involved brain regions.

Fentanyl, an agonist at the mu opioid receptor, depresses pupillary unrest

Pupillary unrest is a chaotic fluctuation in pupil size that is observed in darkness with the onset of drowsiness, and in ambient light. The mechanism of pupillary unrest in darkness as well as in ambient light is unknown but studies suggest that it is caused by fluctuating activity in the Edinger-Westphal (E.W.) nucleus. Neurons in the periaqueductal gray with oscillating firing patterns that are inhibitory to the E.W. nucleus have been described in the cat. We theorized that such oscillating neurons produce pupillary unrest in light and would be depressed by agents, such as opioids, known to depress inhibitory pathways in the midbrain. An infrared pupillometer was used to measure the effect of light on pupillary unrest in eight volunteer subjects, and on 20 patients scheduled for knee arthroscopy who received fentanyl as premedication. Pupillary unrest was quantified through spectral analysis of fast Fourier transforms. Sixteen-second measurements of pupil size at 33 Hz were filtered to eliminate blink artifacts and baseline drift. Pupillary unrest was augmented by excitation of the E.W. nucleus by light and was depressed by 40 ± 20% after the administration of the moderate dose of 1 mcg/kg of fentanyl. Recovery from the drug effect was observed. Based upon the data from this study we propose that pupillary unrest in light originates within oscillating inhibitory neurons that intermittently depress the E. W. nucleus.

Modeling transient pupillary light reflex induced by a short light flash

A pupillary light reflex (PLR) model was proposed in this paper by considering the iris muscle mechanical properties and modulation inputs from both parasympathetic and sympathetic systems. The model can describe very well the experimental PLR responses induced by a short light flash of various intensities. In addition, an inverse method was developed to fit numerically this model to experimental PLR data. The model was tested in experimental human PLR data to extract separately the parasympathetic and sympathetic modulations during PLR. The results indicated a higher parasympathetic and a lower sympathetic activity in females than in males, which was consistent with previous findings in cardiovascular studies. This new model may help improve our understanding of the PLR process and could be applied to analyze autonomic nervous interaction during pupillary responses.

Microarray Analysis and Functional Genomics Identify Novel Components of Melanopsin Signaling

BACKGROUND

Within the mammalian retina, there exists a third photoreceptive system based upon a population of melanopsin (Opn4) expressing photosensitive retinal ganglion cells (pRGCs; also termed ipRGCs or intrinsically photosensitive RGCs). Here, we use a microarray-based approach, which we term transcriptional recalibration, coupled with functional genomics to identify downstream targets of melanopsin signaling.

RESULTS

In a mouse with genetically ablated rods and cones (rd/rd cl), approximately 30% of the ocular transcriptome is transiently regulated in response to nocturnal light exposure (3112 genes). A total of 163 of these genes were associated with the "intracellular signaling" gene ontology term. On the basis of their similarity to invertebrate phototransduction genes, 14 were selected for further study. Laser capture microdissection demonstrated that eight of these genes (Gnas, Gnb2l1, Gnaq, Prkcz, Pik3r1, Inadl, Slc9a3r1, and Drd1a) colocalized with melanopsin. The impact of genetic ablation of one of these genes, protein kinase C zeta (Prkcz), was assessed. Prkcz-/- animals show attenuated phase-shifting responses to light, reduced period lengthening under constant light, and attenuated pupillary responses at high irradiances, as well as impaired light-induced gene expression in the suprachiasmatic nuclei (SCN). These attenuated responses are indistinguishable from the deficits observed in melanopsin knockout mice.

CONCLUSIONS

Here, we show that (1) Prkcz plays an as yet unidentified role in melanopsin signaling, (2) the proteins of seven further light-regulated genes emerge as strong candidates in melanopsin signaling, and (3) transcriptional recalibration may provide a powerful new approach for dissecting unmapped signaling pathways.

Shaping the pupil’s response to light in the hooded rat

The contribution of iris muscle steady state and dynamic response characteristics to the shaping of the pupil response to light in the hooded rat were studied using electrical stimulation of the parasympathetic fibers in the III nerve. The waveforms of pupillary contractions to single or brief trains of electrical impulses applied to the III nerve were virtually identical to those elicited with short duration light flashes. Individual contractions could be resolved at stimulation rates of 2 Hz and below, and the size of the contractions increased with the decrease in frequency. The pupil responded to long trains of stimuli above 2 Hz with smooth tonic contractions. Steady state contraction amplitude was linearly related to log stimulation frequency. The mean time constant of pupil constriction to stimulus trains was 1.41 s (SD +/- 0.71 s) and the shortest mean latency was 292 ms (SD +/- 30 ms). The fastest mean latency of pupil constriction to the brightest light flash used was 295 ms. In contrast, the time constant of pupillary dilation was 7 s (SD +/- 1.4 s) and the shortest latency was 485 ms (SD +/- 74 ms). Therefore, the sluggish dynamic properties of the iris musculature are responsible for the asymmetries in pupil contraction, dilation, and latencies as well as low flicker fusion frequency and constriction amplitude characteristics of pupil responses to light.

A binocular pupil model for simulation of relative afferent pupil defects and the swinging flashlight test

Many important intracranial neural pathways are involved in the control of the two muscles of the human pupil and the observation and analysis of pupil responses to light or other stimuli is of great interest in many clinical procedures. The binocular pupil model presented in this document has a topology encompassing much of the complexity of the pupil system neurophysiology. The dynamic parameters of the model were matched against pupil experiments under multiple conditions. It is employed here to simulate responses to the swinging flashlight test, a procedure which is routinely practiced in ophthalmology to diagnose different degrees of relative afferent pupil defects often a consequence of severe optic nerve diseases or retinal dysfunctions. Other, not light-dependent, pupil stimuli are briefly discussed.

Effects of peripheral sympathetic blockade with dapiprazole on the fear-inhibited light reflex

Fear (e.g. associated with the threat of an electric shock) causes an increase in initial pupil diameter (IPD) and a decrease in the amplitude of the light reflex response. There is evidence for dissociation between the two responses to threat: only the reduction in light reflex response amplitude is sensitive to the anxiolytic drug diazepam. We examined the effects of peripheral sympathetic blockade with the alpha(1)-adrenoceptor antagonist dapiprazole on both responses to threat on the basis of the hypothesis that only the response of the IPD will be affected, whereas the response of the light reflex will remain unaffected. Twelve healthy volunteers (Experiment 1) and eight healthy volunteers with smaller pupils (Experiment 2) participated in one experimental session. Dapiprazole 0.5% (two drops of 20 microl, three times) was instilled in the subjects' right or left eye while the contralateral eye was treated with placebo eye drops (artificial tear, two drops of 20 microl, three times) according to a single-blind balanced design. Pupil diameter was monitored by infrared binocular television pupillometry. At the point of maximum dapiprazole-evoked miosis, the light reflex was elicited three times in each of three Safe blocks (no possibility of electric shock), alternating with three Threat blocks (possibility of electric shock). At the end of each Safe and Threat block, subjects rated their mood and feelings on the Visual Analogue Scales. In Experiment 1, dapiprazole caused significant miosis. Threat increased subjectively rated anxiety and inhibited the light reflex. The inhibition of the light reflex was unaffected by dapiprazole. The threat-induced increase in IPD was also unaffected by dapiprazole, probably due to a ceiling effect curtailing the threat-induced increase in IPD. In the smaller pupil group in Experiment 2, where the possible contribution of a ceiling effect was minimized, dapiprazole suppressed the threat-induced increase in IPD. The inhibition of the light reflex by threat is likely to reflect central parasympathetic inhibition and is unlikely to involve the peripheral sympathetic innervation of the iris. The threat-induced increase in IPD is likely to reflect mainly central sympathetic excitation. The different central autonomic mechanisms underlying the two pupillary responses to threat may explain the dissociation between the separate effects of threat on IPD and light reflex amplitude.

Pupil noise is a discriminator between narcoleptics and controls

The pupil light reflex has a long history of being able to indicate states of mental arousal, ranging from sleepiness to concentrated cognitive effort. Such mental states have usually been inferred from pupil diameter or pupil area movements relative to some reference; sleepiness, for example, is characterized by a smaller than average pupil while mental effort brings on a slightly larger pupil. But all pupil movements and associated states of arousal are accompanied by a persistent random pupil diameter motion which has previously been attributed to neurological noise, the noise apparently arising in the neurological controller of the pupil reflex control system. Our experiments and signal processing methods show that the amplitude of this pupil noise is an indicator of the sleeping disorder narcolepsy. Narcoleptics are found to have diminished pupil noise amplitudes relative to control subjects. Pupil noise is estimated by statistical procedures which yield unbiased noise measures in the form of six-dimensional Gaussian vectors. Each subject is associated with a Gaussian vector which is optimally projected onto a scalar axis so as to maximize the mean square distance between the narcoleptic and control samples. The Kullback-Leibler discrimination function is estimated and then evaluated for each projection as a means of discriminating narcoleptics from controls. The projected noise measures correctly classify 18 out of 20 subjects. The projected values also form the basis for supporting or rejecting a hypothesis of narcoleptic or control class membership. Parametric and nonparametric hypothesis tests suggest that, with probabilities close to one, narcoleptics and controls are distinguishable classes. To emphasize the importance of pupil noise as a diagnostic tool we present evidence from the neurophysiology literature indicating that Alzheimer's disease and narcolepsy have some of the same brainstem nuclei implicated. Further, Alzheimer patients and narcoleptics share some of the same disturbed sleep patterns.

Cells in the pretectal olivary nucleus are in the pathway for the direct light reflex of the pupil in the rat

Extracellular microelectrode recordings from 148 single cells in the pretectum of the hooded rat were classified according to their temporal response properties to light stimulation of their retinal receptive fields. Fifty-six cells were classified as tonic-on cells, 22 cells were classified as tonic-off cells, and 53 cells were classified as phasic cells. Seventeen cells could not be assigned to one of these 3 groups. The diameters of the receptive field centers of the tonic-on pretectal cell were clustered about a mean of 31 degrees and the temporal response of these cells was sustained. Constriction of the contralateral pupil was produced by electrical stimulation through the recording electrode at sites containing tonic-on pretectal cells, but not at sites containing tonic-off pretectal cells or phasic pretectal cells. For this reason, we argue that tonic-on cells are likely to mediate constriction in the light reflex of the rat's pupil. Receptive field maps together with electrolytic marking lesions at recording and stimulation sites showed that tonic-on pretectal cells are retinotopically organized and are aggregated in a strip running from the dorso-medial tip of the pretectum to the ventro-lateral boundary. The anatomical distribution of these cells is coextensive with the region known as the pretectal olivary nucleus (PO) in the rat. Using fine microelectrodes, recordings were obtained from 27 axons presumed to be of optic origin (fibers). Of these, 14 were tonic-on, 10 were phasic, 2 were tonic-off, and 2 were unclassified. Recordings from tonic-on fibers were obtained near tonic-on pretectal cells, typically in the most dorsal light-responsive region of the pretectum. These fibers were activated by single pulse electrical stimulation of the optic chiasm. The mean receptive field center diameter of 6 tonic-on fibers was 10.1 degrees, or about a factor of 3 less than that of pretectal tonic-on cells. The mean conduction velocity of 14 tonic-on fibers was 3.1 m/s. We argue that the tonic-on cells of the PO serve to integrate signals from tonic-on center retinal ganglion cells with adjacent receptive fields to provide signals for constriction of the pupil to neurons in the oculomotor nucleus.

Dynamic pupillary response controlled by the pupil size effect

Pupillary escape has been described as an initial contraction followed by a slow redilatation, occurring in response to a step stimulus of low-intensity light. When the initial pupil size is small, the response to the same step stimulus is pupillary capture, a steady and sustained contraction. In this experiment a comparison was made between three modes of controlling pupil size and thereby of regulating the pupillary response: contralateral light background level, ipsilateral light background level, and accommodative level with which there is no change in retinal adaptation. All three level setting modes showed similar results in illustrating the pupil size effect. In addition, an inhibitory effect was found with both ipsilateral and contralateral light backgrounds that is independent of Weber's Law in the contralateral case. Our results lead to the formulation of a binocular model, featuring an internal parameter control whereby a signal dependent on the static pupil size regulates the gains of the parallel phasic and tonic pathways, the former responsive to transient changes of light, and the latter to background levels of light and accommodative levels. Our findings also raise interesting questions concerning the loci of these complex interactions in the simple neuroanatomy of the pupillary pathways.

Pupillary escape intensified by large pupillary size

Pupil responses to light are greatly influenced by initial pupil size. Small pupils, operating under photopic conditions, show tonic responses to step increases of light and high gains; thus the pupil is a good regulator of light. Large pupils, operating under mesopic or scotopic conditions show phasic responses, "pupillary escape", and smaller gains; the pupil only transiently influences retinal flux. By using accommodation level to set the size of the pupil, the mechanism of the "pupil size effect" is shown to be dependent on retinal light level only so far as retinal activity sets pupil size.