Impact of age on pupillary unrest in ambient light (PUAL) as an indicator of opioid effect in adult subjects
Authors' conclusion
PUAL thresholds for high-risk opioid exposure are consistent between younger and older adults and do not require age-specific adjustment up to age 60.
Study context
- Population
- Healthy adult volunteers receiving a 10-minute remifentanil infusion (0.2–0.3 µg/kg/min) and 25-minute recovery
- Participants
- 10 vs 20
- Comparison
- 40-60 years vs 20-39 years
- 40-60 yearsn = 10
- 20-39 yearsn = 20reference
- Outcome
- Discrimination of high- vs low-risk opioid exposure (modeled remifentanil effect-site concentration threshold) by PUAL
- Follow-up
- During infusion
Methodological detailshealthy volunteers, pooled with previously collected data from younger subjects
- Healthy volunteers
- Pooled with previously collected data from younger subjects
Performance
As reported in the abstract
PUAL discrimination of high- vs low-risk opioid exposure during infusion
- AUROC of PUAL for high- vs low-risk opioid exposure
- 0.9833 (95% CI: 0.8935, 0.9995)
- Interval likelihood ratio (iLR) for high-toxic opioid effect, PUAL < 0.04
- 27.98 (95% CI: 1.79, 438.33)
- iLR for high-toxic opioid effect, PUAL 0.04-< 0.14
- 0.75 (95% CI: 0.38, 1.50)
- iLR for high-toxic opioid effect, PUAL ≥ 0.14
- 0.030 (95% CI: 0.002, 0.477)
- No significant difference in discriminatory performance vs younger subjects
- chi2 = 1.02, p = 0.3129
Further findings
PUAL over time
- PUAL declined during infusion and increased toward baseline during recovery
- P < 0.001
PUAL slope by age group
- During recovery flatter slope in older subjects
- P = 0.016
- During infusion no significant difference in slope or CEREMI between age groups
Original publication
Impact of age on PUAL as an indicator of opioid effect in adult subjects. J Clin Monit Comput. Published 18 August 2025. doi:10.
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