Atropine abolishes electroencephalogram‐associated heart rate changes without an effect on respiratory sinus arrhythmia during anaesthesia in humans

Yli‐Hankala, Arvi; Loula, Pekka; Annila, P.; Lindgren, L.; Jäntti, V.

doi:10.1111/j.1748-1716.1993.tb09640.x

Cited by 8 publications

(3 citation statements)

References 18 publications

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“…Our previous studies support this, showing the correlation between EEG transients and heart rate [20], as well as the reversed phase relationship of RSA during positive pressure ventilation [15]. Anticholinergics do not abolish RSA during anaesthesia and mechanical ventilation [21], although this is the case during spontaneous breathing [22,23]. The resistance to anticholinergics, together with the reversed phase relationship, suggests that the control mechanisms of RSA during positive pressure ventilation differ from thQse during spontaneous breathing while awake.…”

Section: Discussionsupporting

confidence: 51%

Respiratory sinus arrhythmia during anaesthesia: assessment of respiration related beat-to-beat heart rate variability analysis methods

Loula

Jäntti

Yli‐Hankala

1997

Int. J. Clin. Mon. Comp.

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Beat-to-beat heart rate variability analysis is a powerful tool for the diagnosis of neuropathy. Respiration-related heart rate variability (respiratory sinus arrhythmia, RSA) reflects the function of parasympathetic nervous system during spontaneous ventilation while awake. RSA is also claimed to monitor the depth of anaesthesia. Power spectrum analysis or various averaging techniques of the heart rate variability are usually applied. The current literature, however, does not usually interpret the ground rules and limitations of the method used, and this may sometimes lead to erroneous conclusions on the data. The aim of our study was to compare and analyse critically the performance of different methods of evaluating RSA during anaesthesia and positive pressure ventilation. Power spectrum analysis, the root mean square of the successive RR-interval difference (RMSSD), and two respiration related methods, RSA index and average phase RSA, were included in the comparison. To test these methods, 11 patients were anaesthetised with isoflurane and their lungs were ventilated mechanically with a frequency of 6 cycles min-1. Each patient received a bolus dose of atropine (20 micrograms kg-1) during the trial. Electrocardiogram, electroencephalogram and tracheal pressure signal from respirator were recorded and analyses were performed off-line. We demonstrated that general indices, such as RMSSD, may be strongly affected by heart rate level and other non-respiration related variations in heart rate. We also showed that the effect of unwanted fluctuations on RSA can be reduced with respiration dependent beat-to-beat methods. Furthermore we confirmed that in addition to the amplitude, also the pattern of respiratory sinus arrhythmia is of interest: the pattern is reversed in phase compared to spontaneous breathing while awake, as we have shown earlier. To analyse RSA during anaesthesia, we recommend the use of an average phase RSA method based on beat-to-beat variability that shows both the amplitude and pattern of RSA. Finally, no measure of RSA should be used without a presentation of the actual beat-to-beat heart rate curve.

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Section: Discussionsupporting

confidence: 51%

Respiratory sinus arrhythmia during anaesthesia: assessment of respiration related beat-to-beat heart rate variability analysis methods

Loula

Jäntti

Yli‐Hankala

1997

Int. J. Clin. Mon. Comp.

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“…The respiratory component (HF) is also markedly reduced, but it represents the main contribution to overall variability as attested by the normalized values. Under general anaesthesia, the determinant of this residual respiratory sinus dysrhythmia (RSA) is still debated: it may be due to residual parasympathetic activity related to the depth of anaesthesia (17) or to parasympathetic independent mechanical influence of positive pressure ventilation on the sinus node (18). The LF oscillations of BP reflect efferent sympathetic vasomotor activity (3), which depends on the integrity of the autonomic nervous system and may stem from a central oscillator of sympathetic tone.…”

Section: Discussionmentioning

confidence: 99%

Assessment of autonomic cardiovascular changes associated with recovery from anaesthesia in children: a study using spectral analysis of blood pressure and heart rate variability

Constant¹,

Laude²,

Elghozi³

et al. 2000

Pediatric Anesthesia

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Recovery from anaesthesia is associated with large changes in cardiovascular autonomic activity, which are poorly documented in children. This study was undertaken to investigate the cardiovascular autonomic activity in anaesthetized and recovering children, using a noninvasive approach based on spectral analysis of heart rate (HR) and blood pressure (BP) variability. Ten children (aged 5-13 years) undergoing major surgery were studied. Continuous HR and BP were recorded using a noninvasive device during deep anaesthesia and recovery. Spectral analysis was used to determine the main oscillatory components of HR and BP signals. For each power spectrum, the frequency components were identified as follows (i): the low frequency (LF) component (0.04-0.14 Hz) both parasympathetically and sympathetically mediated for HR and corresponding to vasomotor sympathetic modulation for BP; and (ii) the high frequency (HF) component (0.2-0.6 Hz) parasympathetically mediated for HR, and reflecting mechanical influence of ventilation on cardiac output for BP. In addition, the LF : HF ratio for HR, reflecting the cardiac sympathovagal balance, was calculated. Under deep anaesthesia, HR variability and BP variability were very low and mainly due to mechanical influence of intermittent positive pressure ventilation. Conversely, the recovery period was associated with a marked increase of HR and BP overall variability. Compared to anaesthesia, spectral analysis of HR and BP revealed that the LF component of BP and HR spectra increased 40-fold during recovery; the LF : HF ratio of HR was also increased during recovery (0.1 +/- 0.1 versus 1.3 +/- 1.2, P=0.008). The results of this study demonstrate that the recovery period is associated with an increase of cardiovascular sympathetic drive in children after major surgery.

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“…Both heart rate variability and alterations in the systemic and cerebral circulation (Cerebral Blood Flow, CBF) occur during BS. Researchers have hypothesized a unified subcortical mechanism underpinning both the BS cortical activity and heart rate fluctuations [73]. Characteristically, the onset of EEG suppression precedes the reduction of CBF by 5-7 seconds during inhalatory anaesthesia.…”

Section: Burst-suppressionmentioning

confidence: 99%

A pragmatic approach to intravenous anaesthetics and electroencephalographic endpoints for the treatment of refractory and super-refractory status epilepticus in critical care

Prisco

Ganau

Aurangzeb

et al. 2020

Seizure

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Status epilepticus is a common neurological emergency, with overall mortality around 20%. Over half of cases are first time presentations of seizures. The pathological process by which spontaneous seizures are generated arises from an imbalance in excitatory and inhibitory neuronal networks, which if unchecked, can result in alterations in intracellular signalling pathways and electrolyte shifts, which bring about changes in the blood brain barrier, neuronal cell death and eventually cerebral atrophy. This narrative review focusses on the treatment of status epilepticus in adults. Anaesthetic agents interrupt neuronal activity by enhancing inhibitory or decreasing excitatory transmission, primarily via GABA and NMDA receptors. Intravenous anaesthetic agents are commonly used as second or third line drugs in the treatment of refractory status epilepticus, but the optimal timing and choice of anaesthetic drug has not yet been established by high quality evidence. Titration of antiepileptic and anaesthetic drugs in critically ill patients presents a particular challenge, due to alterations in drug absorbtion and metabolism as well as changes in drug distrubution, which arise from fluid shifts and altered protein binding. Furthermore, side effects associated with prolonged infusions of anaesthetic drugs can lead to multi-organ dysfunction and a need for critical care support. Electroencelography can identify patterns of burst suppression, which may be a target to guide weaning of intravenous therapy. Continuous elctroencephalography has the potential to directly impact clinical care, but despite its utility, major barriers exist which have limited its widespread use in clinical practice. A flow chart outlining the timing and dosage of anaesthetic agents used at our institution is provided.

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Atropine abolishes electroencephalogram‐associated heart rate changes without an effect on respiratory sinus arrhythmia during anaesthesia in humans

Cited by 8 publications

References 18 publications

Respiratory sinus arrhythmia during anaesthesia: assessment of respiration related beat-to-beat heart rate variability analysis methods

Respiratory sinus arrhythmia during anaesthesia: assessment of respiration related beat-to-beat heart rate variability analysis methods

Assessment of autonomic cardiovascular changes associated with recovery from anaesthesia in children: a study using spectral analysis of blood pressure and heart rate variability

A pragmatic approach to intravenous anaesthetics and electroencephalographic endpoints for the treatment of refractory and super-refractory status epilepticus in critical care

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