Effects of pneumoperitoneum on cardiac autonomic nervous activity evaluated by heart rate variability analysis during sevoflurane, isoflurane, or propofol anesthesia

Abstract

Our results suggest that pneumoperitoneum increases sympathetic cardiac activity. The choice of general anesthetic did not seem to have a major influence on the change in the cardiac autonomic nervous system after induction of pneumoperitoneum for laparoscopic cholecystectomy.

Power spectral analysis of heart rate variability during positive pressure pneumoperitoneum

“…Another proposed mechanism is direct mechanical stimulation by abdominal wall and diaphragmatic distention during insufflation, as well as phrenic nerve irritation, all of which might cause sympathetic activation [35].…”

“…Increased sympathetic cardiac activity was recently suggested by spectral analysis during pneumoperitoneum [35]. However, the clinical aspects of the influence of PPP, as well as other points (such as additional data concerning the spectral analysis, drug interactions, and possible prognostic significance), were not assessed.…”

Cardiovascular autonomic function in patients with hemodynamic instability at induction of capnoperitoneum: a case–control study

“…Previous work with heart rate variability analysis has shown that the bradycardia seen immediately after carbon dioxide insufflation of the abdomen is vagally mediated [5]. This is followed by an increase in the sympathetic tone [3,17], which seems to be directly correlated with the degree of intraabdominal pressure [2,18]. The precedence of parasympathetic over sympathetic effect on the heart rate at induction of PPCpn may be attributable to a more rapid response of the heart rate to parasympathetic stimulation than to sympathetic stimuli [13].…”

Power spectral analysis of heart rate variability during helium pneumoperitoneum: The mechanism of increased cardiac sympathetic activity and its clinical significance

“…This may also lead to changes in cardiac autonomic nervous control, manifesting as increased cardiac sympathetic activity. Such sequelae may have serious consequence, especially by lowering the threshold for ventricular arrhythmias, [2,22]. In general, changes in the cardiac autonomic control system are manifested by the synergistic action of its sympathetic and parasympathetic branches, can be quantified, and reflect the autonomic tone [13].…”

“…Theories proposed to explain the mechanism responsible for increased sympathetic activity during PP include increased baroreceptor reflex activity due to decreased venous return and cardiac output, the influence of anesthetic drugs, the direct mechanical effect of peritoneal insufflation through diaphragmatic and phrenic nerve stretching, as well as direct and indirect effects of hypercarbia [2,22]. Various inert gases, such as helium, were suggested as a CO 2 substitute in an attempt to decrease the cardiorespiratory and metabolic effects during PP induction.…”