Baroreflex sensitivity variations in response to propofol anesthesia: comparison between normotensive and hypertensive patients

Dorantes-Méndez, Guadalupe; Aletti, Federico; Toschi, Nicola; Canichella, Antonio; Dauri, Mario; Coniglione, Filadelfo; Guerrisi, Maria; Signorini, M.G.; Cerutti, S.; Ferrario, Manuela

doi:10.1007/s10877-012-9426-1

Cited by 26 publications

(17 citation statements)

References 32 publications

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“…Extraction and archiving of monitoring data were performed with custom software built in-house 38 . Full details of intraoperative instrumentation and data collection are in previous work 38 – 40 and online Supplementary Material 1 . Analysis proceeded as follows (Fig.…”

Section: Methodsmentioning

confidence: 99%

Prediction of postoperative outcomes using intraoperative hemodynamic monitoring data

Prasad

Guerrisi

Dauri

et al. 2017

Sci Rep

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Major surgeries can result in high rates of adverse postoperative events. Reliable prediction of which patient might be at risk for such events may help guide peri- and postoperative care. We show how archiving and mining of intraoperative hemodynamic data in orthotopic liver transplantation (OLT) can aid in the prediction of postoperative 180-day mortality and acute renal failure (ARF), improving upon predictions that rely on preoperative information only. From 101 patient records, we extracted 15 preoperative features from clinical records and 41 features from intraoperative hemodynamic signals. We used logistic regression with leave-one-out cross-validation to predict outcomes, and incorporated methods to limit potential model instabilities from feature multicollinearity. Using only preoperative features, mortality prediction achieved an area under the receiver operating characteristic curve (AUC) of 0.53 (95% CI: 0.44–0.78). By using intraoperative features, performance improved significantly to 0.82 (95% CI: 0.56–0.91, P = 0.001). Similarly, including intraoperative features (AUC = 0.82; 95% CI: 0.66–0.94) in ARF prediction improved performance over preoperative features (AUC = 0.72; 95% CI: 0.50–0.85), though not significantly (P = 0.32). We conclude that inclusion of intraoperative hemodynamic features significantly improves prediction of postoperative events in OLT. Features strongly associated with occurrence of both outcomes included greater intraoperative central venous pressure and greater transfusion volumes.

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Section: Methodsmentioning

confidence: 99%

Prediction of postoperative outcomes using intraoperative hemodynamic monitoring data

Prasad

Guerrisi

Dauri

et al. 2017

Sci Rep

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“…We cannot ignore the depressant effect of pentobarbital anesthesia on reflexes, but at the same time it is important to take into account that the values of the BRS estimates are in agreement with the literature [34, 35], albeit in unconscious animals. Nonetheless, previous reports from our and other laboratories have already shown the robustness of the application of BRS models to data collected from patients under anesthesia, as well as the importance of introducing such indices to characterize the ANS performance in the surgical or ICU setting [24, 36, 37]. …”

Section: Discussionmentioning

confidence: 99%

“…The relationship between HP and SBP was assessed by means of a closed loop model [23, 24] accounting for both the feedback (FB) control of HP by baroreflex (i.e. SBP as the input, HP as the output) and the feed-forward (FF) mechanism (i.e.…”

Section: Methodsmentioning

confidence: 99%

Heart period and blood pressure characteristics in splanchnic arterial occlusion shock-induced collapse

Aletti

Gambarotta

Penn

et al. 2015

J Clin Monit Comput

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The nature of hemodynamic instability typical of circulatory shock is not well understood, but an improved interpretation of its dynamic features could help in the management of critically ill patients. The objective of this work was to introduce new metrics for the analysis of arterial blood pressure (ABP) in order to characterize the risk of catastrophic outcome in splanchnic arterial occlusion (SAO) shock. Continuous ABP (fs = 1 kHz) was measured in rats during experimental SAO shock, which induced a fatal pressure drop (FPD) in ABP. The FPD could either be slow (SFPD) or fast (FFPD), with the latter causing cardiovascular collapse. Time series of mean arterial pressure, systolic blood pressure and heart period were derived from ABP. The sample asymmetry-based algorithm Heart Rate Characteristics was adapted to compute the Heart Period Characteristics (HPC) and the Blood Pressure Characteristics (BPC). Baroreflex sensitivity (BRS) was assessed by means of a bivariate model. The approach to FPD of the animals who collapsed (FFPD) was characterized by higher BRS in the low frequency band versus SFPD animals (0.36 ± 0.15 vs. 0.19 ± 0.12 ms/mmHg, p value = 0.0196), bradycardia as indicated by the HPC (0.76 ± 0.57 vs. 1.94 ± 1.27, p value = 0.0179) and higher but unstable blood pressure as indicated by BPC (3.02 ± 2.87 vs. 1.47 ± 1.29, p value = 0.0773). The HPC and BPC indices demonstrated promise as potential clinical markers of hemodynamic instability and impending cardiovascular collapse, and this animal study suggests their test in data from intensive care patients.

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“…Барорецепторная дисфункция, связанная с нарушением вегетативного гомеостаза, повышает уязвимость организма к гипотензивному воздействию общей анестезии [55,56]. Пациенты с хронической артериальной гипертензией имеют более низкие исходные значения ЧБР и демонстрируют более выраженное снижение как систолического, так и диастолического давления после применения пропофола [57]. Кроме того, эндотрахеальная интубация, которая является симпатическим стимулом и должна повышать артериальное давление, напротив, снижает его у больных хронической артериальной гипертензией и с низким уровнем ЧБР [58].…”

Section: болевой синдром и чувствительность барорефлексаunclassified

Predictive role of baroreflex sensitivity in the assessment of perioperative risk. Article

Zabolotskikh

Трембач

2020

Annals of Critical Care

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Violation of baroreflex sensitivity often accompanies the progression of chronic diseases. Given the fact that baroreflex dysfunction has long been known as a longterm prognostic marker of adverse cardiovascular disease outcomes, interest in the role of baroreflex sensitivity assessment in determining perioperative risk has increased significantly over the past decades. An analysis of the literature showed that for the query “baroreflex” + “anesthesia”, an automatic search in the PubMed database allows you to select 592 research papers, of which only 28 are randomized controlled trials. A significant amount of experimental and clinical data has been accumulated, indicating an important role of baroreflex during the perioperative period. The conducted research allows us to state with confidence the fact that the sensitivity of the baroreflex, equal to 3 ms/mm Hg regardless of the method of its assessment, it is a critical value below which the baroreflex function is associated with an increase in the probability of an adverse outcome, including the development of perioperative complications. The pathophysiological mechanisms underlying the increase in risk with a decrease in baroreflex sensitivity include an increase in the frequency of hemodynamic critical incidents, a greater susceptibility to the negative effects of mechanical ventilation, an increase in the need for infusion-transfusion therapy, a more pronounced pain syndrome and a violation of the immune system. The negative effect of general anesthetics and neuroaxial anesthesia on baroreflex leads to a further increase in risk. Given the role of baroreflex in the pathogenesis of perioperative disorders, the assessment of baroreflex can be a key point of an individual approach to the management of the perioperative period.

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Baroreflex sensitivity variations in response to propofol anesthesia: comparison between normotensive and hypertensive patients

Cited by 26 publications

References 32 publications

Prediction of postoperative outcomes using intraoperative hemodynamic monitoring data

Prediction of postoperative outcomes using intraoperative hemodynamic monitoring data

Heart period and blood pressure characteristics in splanchnic arterial occlusion shock-induced collapse

Predictive role of baroreflex sensitivity in the assessment of perioperative risk. Article

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