Analysis of heart rate variability to assess hemodynamic alterations following induction of anesthesia

Estafanous, Fawzy G.; Brum, José M.; Ribeiro, Marcio P.; Estafanous, Marc; Starr, Norman J.; Ferrario, Carlos M.

doi:10.1016/1053-0770(92)90045-9

Cited by 33 publications

(18 citation statements)

References 34 publications

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“…The observed decrease in physiological heart rate variability indicates the uncoupling of organ systems generally seen in critically ill patients . Sedatives and analgesics have been shown to contribute to the loss of variability (Estafanous et al, 1992;Kanaya et al, 2003); however, as large decreases in HRV are also found during experimental human endotoxemia (LPS administration in healthy volunteers; Jan et al, 2010;Kox et al, 2011b), other factors must also play a role. Brain injury patients exhibited higher HFnu and lower LF:HF ratios compared to healthy volunteers, suggesting a shift in the balance between cardiac autonomic activity towards increased vagus nerve signaling.…”

Section: Discussionmentioning

confidence: 99%

The Effects of Brain Injury on Heart Rate Variability and the Innate Immune Response in Critically Ill Patients

Kox

Vrouwenvelder

Pompe

et al. 2012

Journal of Neurotrauma

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Brain injury and its related increased intracranial pressure (ICP) may lead to increased vagus nerve activity and the subsequent suppression of innate immunity via the cholinergic anti-inflammatory pathway. This may explain the observed increased susceptibility to infection in these patients. In the present study, we investigated the association between brain injury, vagus nerve activity, and innate immunity. We determined heart rate variability (HRV) as a measure of vagus nerve activity, plasma cytokines, and cytokine production of ex vivo lipopolysaccharide-stimulated whole blood in the first 4 days of admission to the neurological intensive care unit (ICU) in 34 patients with various forms of brain damage. HRV, immune parameters, and the correlations between these measures were analyzed in the entire group of patients and in subgroups of patients with conditions associated with high (intracranial hemorrhage [ICH]) and normal ICP (subarachnoid hemorrhage [SAH] with an extraventricular drain alleviating ICP). Healthy volunteers were used for comparison. HRV total spectral power and ex vivo-stimulated cytokine production were severely depressed in patients compared with healthy volunteers (p<0.05). Furthermore, HRV analysis showed that normalized units of high-frequency power (HFnu, corresponding with vagus nerve activity) was higher, and the low-frequency:high-frequency ratio (LF:HF, corresponding with sympathovagal balance) was lower in patients compared to healthy volunteers (p<0.05). HFnu correlated inversely with ex vivo-stimulated tumor necrosis factor-α (TNF-α) production (r=-0.22, p=0.025). The most pronounced suppression of ex vivo-stimulated cytokine production was observed in the ICH group. Furthermore, in ICH patients, HFnu correlated strongly with lower plasma TNF-α levels (r=-0.73, p=0.002). Our data suggest that brain injury, and especially conditions associated with increased ICP, is associated with vagus nerve-mediated immune suppression.

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Section: Discussionmentioning

confidence: 99%

The Effects of Brain Injury on Heart Rate Variability and the Innate Immune Response in Critically Ill Patients

Kox

Vrouwenvelder

Pompe

et al. 2012

Journal of Neurotrauma

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“…They have been shown to reduce the sympathetic nervous activity, to alter the arterial baroreflex, and to decrease the total spectral power of arterial pressure [6,[8][9][10]. They have been shown to reduce the sympathetic nervous activity, to alter the arterial baroreflex, and to decrease the total spectral power of arterial pressure [6,[8][9][10].…”

Section: Anaesthesiamentioning

confidence: 99%

“…Additional changes also result from surgical stimuli [6,7]. HR variability has been studied following induction of anaesthesia with various drugs to assess haemodynamic alterations [8][9][10]. Spectral analysis of HR allowed identifying patients at high risk of developing haemodynamic alterations following anaesthesia [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

“…HR variability has been studied following induction of anaesthesia with various drugs to assess haemodynamic alterations [8][9][10]. Spectral analysis of HR allowed identifying patients at high risk of developing haemodynamic alterations following anaesthesia [8][9][10]. Cardiopulmonary bypass (CPB) during cardiac surgery might provide unique insight into the mechanisms of arterial pressure variability because HR and respiratory influences are absent.…”

Section: Introductionmentioning

confidence: 99%

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Blood pressure and heart rate variability changes during cardiac surgery with cardiopulmonary bypass

Neto¹,

Loufouat²,

Saroul³

et al. 2004

Fundamemntal Clinical Pharma

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This study investigated patients undergoing elective cardiac surgery to evaluate the effects of cardiopulmonary bypass (CPB) on the spontaneous variability of mean arterial pressure (MAP) and heart rate (HR). Forty-one adult patients receiving different cardiovascular system drugs were included in the study. Patients were divided into three groups: no preoperative pharmacological cardiovascular treatment (n = 12), beta-blocker (BB) (n = 13), and angiotensin-converting enzyme inhibition (ACEI) (n = 16). MAP was recorded before anaesthesia until the end of surgery. MAP and HR variability was analysed in very low- (VLF), low- (LF) and high-frequency bands. The LF spectral component of MAP was observed to decrease in patients under ACEI (-92%) or BB (-87%) following induction of anaesthesia. In addition, during CPB, VLF power decreased in BB group (-67%), and LF power decreased in ACEI group (-77%). Concerning HR, VLF spectral power decreased following anaesthesia in BB group (-74%). In addition, after CPB, VLF power reached lower value in ACEI group than in BB group (P < 0.05). LF spectral power of HR showed a large decrease after CPB in ACEI group (-89%). This study showed that MAP variability did not change during CPB in patients with no preoperative pharmacological cardiovascular treatment, suggesting an unaltered vascular control of MAP. Moreover, the change in LF spectral power of MAP in ACEI and BB groups, suggests that both the renin-angiotensin and sympathetic systems participate to the genesis of LF variability of MAP.

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“…The incidence of intraoperative bradycardia with a sufentanil-vecuronium combination was predictably high (8). The patients who did not develop intraoperative bradycardia had higher preoperative HR values than those who subsequently required chronotropic treatment.…”

Section: Discussionmentioning

confidence: 96%

Comparison of Transesophageal Atrial Pacing with Anticholinergic Drugs for the Treatment of Intraoperative Bradycardia

Smith

Monk

White

1994

Anesthesia & Analgesia

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We compared the effectiveness of atropine, glycopyrrolate, and a transesophageal atrial pacing (TAP) stethoscope for treating intraoperative bradycardia in 64 unpremedicated patients receiving a standardized sufentanil/N2O/vecuronium anesthetic. Patients were allocated randomly to receive either atropine, 5 micrograms/kg (Group 1), glycopyrrolate, 2.5 micrograms/kg (Group 2), or transesophageal atrial pacing (Group 3) after the onset of bradycardia, defined as a heart rate of < or = 50 beats/min (or < or = 60 beats/min with concurrent hypotension). Bradycardia occurred in 15 patients of each treatment group. The time required for the heart rate to increase to > or = 70 beats/min was 270 (range 30-490), 270 (70-465), and 12 (2-30) s in Groups 1, 2, and 3, respectively. Although all patients in Group 3 responded to pacing at 150% of the threshold current, 10 patients in Group 1 and 8 patients in Group 2 required a second dose of anticholinergic medication before a heart rate response was observed. One patient in Group 2 required three doses, and another who did not respond even after four doses was treated with the TAP device. Bradycardia subsequently recurred in five patients in Group 1 and four patients in Group 2. Temporary recurrence of bradycardia occurred in seven patients in Group 3 due to outward migration of the pacing stethoscope. However, heart rates were more consistently maintained in paced patients. There were no significant differences in postoperative side effects between the three groups, or when compared with patients who did not receive treatment for bradycardia.(ABSTRACT TRUNCATED AT 250 WORDS)

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Analysis of heart rate variability to assess hemodynamic alterations following induction of anesthesia

Cited by 33 publications

References 34 publications

The Effects of Brain Injury on Heart Rate Variability and the Innate Immune Response in Critically Ill Patients

The Effects of Brain Injury on Heart Rate Variability and the Innate Immune Response in Critically Ill Patients

Blood pressure and heart rate variability changes during cardiac surgery with cardiopulmonary bypass

Comparison of Transesophageal Atrial Pacing with Anticholinergic Drugs for the Treatment of Intraoperative Bradycardia

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