{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T22:53:07Z","timestamp":1793400787458,"version":"4.5.0"},"reference-count":15,"publisher":"SAGE Publications","issue":"10","license":[{"start":{"date-parts":[[2021,9,2]],"date-time":"2021-09-02T00:00:00Z","timestamp":1630540800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Palliat Med"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Palliative sedation is sometimes interrupted by undesired arousals. Pupillometry has been used in anesthesiology to monitor pain and sedation but has never been used during palliative sedation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Actual case:<\/jats:title>\n                    <jats:p>A 48\u2009years-old patient, with multi-metastatic cancer, underwent palliative sedation to manage global suffering. On the second day, the patient experienced arousal which required medication adjustments to ensure pain relief and increased sedation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Possible course of action:<\/jats:title>\n                    <jats:p>Depth of sedation is monitored with clinical scales, such as the Richmond Agitation-Sedation Scale. But these scales do not measure brain stem activity and are poor at predicting arousal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Formulation of a plan:<\/jats:title>\n                    <jats:p>\n                      During palliative sedation, an infrared pupillometer was used to monitor pupil size and pupillary reactivity (Neurolight\n                      <jats:sup>\u00ae<\/jats:sup>\n                      , IDMed\n                      <jats:sup>\u00ae<\/jats:sup>\n                      , Marseille, France).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome:<\/jats:title>\n                    <jats:p>The pupillary light reflex was depressed during deep sedation. In our case, we observed a low-normal reflex along with dilated pupil before arousal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Lessons from the case:<\/jats:title>\n                    <jats:p>Our case suggests that reflex intensity and pupil size might predict arousals during palliative sedation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>View on research problems, objectives, or questions generated by the case:<\/jats:title>\n                    <jats:p>Prospective studies are needed to confirm our findings. Pupillometry\u2019s acceptability should also be questioned from patient\u2019s, families\u2019, and caregivers\u2019 perspectives.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/02692163211042770","type":"journal-article","created":{"date-parts":[[2021,9,2]],"date-time":"2021-09-02T09:18:28Z","timestamp":1630574308000},"page":"2024-2027","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Monitoring the depth of palliative sedation by video-pupillometry: A case report"],"prefix":"10.1177","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2764-4351","authenticated-orcid":false,"given":"Antoine","family":"Elyn","sequence":"first","affiliation":[{"name":"Chronic Pain Unit, Neuroscience Department, University Hospital of Toulouse, Toulouse, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Saffon","sequence":"additional","affiliation":[{"name":"Palliative Care Unit, Geriatrics and Internal Medicine Department, University Hospital of Toulouse, Toulouse, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Merlin","family":"Larson","sequence":"additional","affiliation":[{"name":"Anesthesia and Peri-Operative Care, University of California, San Francisco, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2021,9,2]]},"reference":[{"key":"bibr1-02692163211042770","doi-asserted-by":"publisher","DOI":"10.1136\/bmjspcare-2018-001712."},{"key":"bibr2-02692163211042770","doi-asserted-by":"publisher","DOI":"10.1177\/0269216319871666"},{"key":"bibr3-02692163211042770","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2013.04.038"},{"key":"bibr4-02692163211042770","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2016.12.335"},{"key":"bibr5-02692163211042770","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-016-1349-7"},{"key":"bibr6-02692163211042770","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-199107000-00011"},{"key":"bibr7-02692163211042770","doi-asserted-by":"publisher","DOI":"10.1213\/00000539-199305000-00028"},{"key":"bibr8-02692163211042770","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000000314"},{"key":"bibr9-02692163211042770","doi-asserted-by":"publisher","DOI":"10.4103\/2152-7806.82248"},{"key":"bibr10-02692163211042770","doi-asserted-by":"publisher","DOI":"10.1186\/2110-5820-3-5"},{"key":"bibr11-02692163211042770","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000000384"},{"key":"bibr12-02692163211042770","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000000624"},{"key":"bibr13-02692163211042770","doi-asserted-by":"publisher","DOI":"10.1016\/j.autneu.2015.01.004"},{"key":"bibr14-02692163211042770","first-page":"279","volume":"10","author":"McKay RE","year":"2018","journal-title":"Anesth Analg"},{"key":"bibr15-02692163211042770","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000001802"}],"container-title":["Palliative Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/02692163211042770","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/02692163211042770","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/02692163211042770","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T18:32:09Z","timestamp":1777660329000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/02692163211042770"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,2]]},"references-count":15,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["10.1177\/02692163211042770"],"URL":"https:\/\/doi.org\/10.1177\/02692163211042770","relation":{},"ISSN":["0269-2163","1477-030X"],"issn-type":[{"value":"0269-2163","type":"print"},{"value":"1477-030X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,2]]}}}