Evaluation of Autonomic Reserves in Cardiac Surgery Patients

Deschamps, Alain; Denault, André; Rochon, Antoine; Cogan, Jennifer; Pagé, Pierre; DʼAntono, Bianca

doi:10.1053/j.jvca.2012.07.016

Cited by 13 publications

(13 citation statements)

References 44 publications

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“…While it is well-recognized that cardiovascular autonomic neuropathy in diabetic patients may result in unexpected hemodynamic instability during surgery, [20] very few studies have analyzed the impact of autonomic dysfunction on post/peri-operative outcomes in a general population or in cardiac surgery patients. [21, 22]…”

Section: Introductionmentioning

confidence: 99%

Baroreflex sensitivity and outcomes following coronary surgery

Ranucci¹,

Porta²,

Bari³

et al. 2017

PLoS ONE

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Postoperative atrial fibrillation, acute kidney dysfunction and low cardiac output following coronary surgery are associated with morbidity and mortality. The purpose of this study is to determine if the preoperative autonomic control is a determinant of these postoperative complications. This is a prospective cohort study on 150 adult patients undergoing surgical coronary revascularization with cardiopulmonary bypass. The patients received an autonomic control assessment after the induction of anesthesia. Baroreflex sensitivity was computed by spectral analysis and expressed as BRSαHF and BRSαLF for measure respectively in the high and low frequency domains. Atrial fibrillation was adjudicated at any postoperative time during the hospital stay. Acute kidney dysfunction was defined as any increase of serum creatinine levels from preoperative values within the first 48 hours after surgery, and acute kidney injury was adjudicated at a 50% increase. Low cardiac ouput syndrome was defined as the need for inotropic support > 48 hours. Thirty-eight (26.4%) patients experienced postoperative atrial fibrillation; 32 (22.2%) had acute kidney dysfunction and 5 (3.5%) acute kidney injury; 14(10%) had a low cardiac output state. No indices of baroreflex sensitivity were associated with atrial fibrillation or acute kidney injury. A low value of BRSαLF was associated with acute kidney dysfunction and low cardiac output state. A BRSαLF < 3 msec/mmHg was an independent risk factor for acute kidney dysfunction (odds ratio 3.0, 95% confidence interval 1.02–8.8, P = 0.045) and of low cardiac output state (odds ratio 17.0, 95% confidence interval 2.9–99, P = 0.002). Preoperative baroreflex sensitivity is linked to postoperative complications through a number of possible mechanisms, including an autonomic nervous system-mediated vasoconstriction, a poor response to hypotension, and an increased inflammatory reaction.

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Section: Introductionmentioning

confidence: 99%

Baroreflex sensitivity and outcomes following coronary surgery

Ranucci¹,

Porta²,

Bari³

et al. 2017

PLoS ONE

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“… 6 – 8 , 17 The use of some autonomic challenge (ie, the Valsalva maneuver or orthostatic load) can improve HRV measurement and better reflect the real degree of autonomic physiological reserves, in contrast to measurements under static conditions. 10 , 11 In our study, we used orthostatic load which can help us identify patients without autonomic reactivity (NCAR) among elderly patients with comorbidities scheduled for MAS. NCAR was characterized by a plain chart of HRV patterns without reactivity in particular positions and low TP in the supine-2 position (TP <200 ms 2 ).…”

Section: Discussionmentioning

confidence: 99%

“…However, some autonomic challenges, such as orthostatic load or the Valsalva maneuver, can improve the sensitivity of ANS assessment and better reflect the real autonomic physiological reserves of patients. 10 , 11 …”

Section: Introductionmentioning

confidence: 99%

Role of heart-rate variability in preoperative assessment of physiological reserves in patients undergoing major abdominal surgery

Reimer¹,

Máca²,

Szturz³

et al. 2017

TCRM

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BackgroundMajor abdominal surgery (MAS) is associated with increased morbidity and mortality. The main objective of our study was to evaluate the predictive value of heart-rate variability (HRV) concerning development of postoperative complications in patients undergoing MAS. The secondary objectives were to identify the relationship of HRV and use of vasoactive drugs during anesthesia, intensive care unit length of stay (ICU-LOS), and hospital length of stay (H-LOS).Patients and methodsSixty-five patients scheduled for elective MAS were enrolled in a prospective, single-center, observational study. HRV was measured by spectral analysis (SA) preoperatively during orthostatic load. Patients were divided according to cardiac autonomic reactivity (CAR; n=23) and non-cardiac autonomic reactivity (NCAR; n=30).ResultsThe final analysis included 53 patients. No significant difference was observed between the two groups regarding type of surgery, use of minimally invasive techniques or epidural catheter, duration of surgery and anesthesia, or the amount of fluid administered intraoperatively. The NCAR group had significantly greater intraoperative blood loss than the CAR group (541.7±541.9 mL vs 269.6±174.3 mL, p<0.05). In the NCAR group, vasoactive drugs were used during anesthesia more frequently (n=21 vs n=4; p<0.001), and more patients had at least one postoperative complication compared to the CAR group (n=19 vs n=4; p<0.01). Furthermore, the NCAR group had more serious complications (Clavien–Dindo ≥ Grade III n=6 vs n=0; p<0.05) and a greater number of complications than the CAR group (n=57 vs n=5; p<0.001). Significant differences were found for two specific subgroups of complications: hypotension requiring vasoactive drugs (NCAR: n=10 vs CAR: n=0; p<0.01) and ileus (NCAR: n=11 vs CAR: n=2; p<0.05). Moreover, significant differences were found in the ICU-LOS (NCAR: 5.7±3.5 days vs CAR: 2.6±0.7 days; p<0.0001) and H-LOS (NCAR: 12.2±5.6 days vs CAR: 7.2±1.7 days; p<0.0001).ConclusionPreoperative HRV assessment during orthostatic load is objective and useful for identifying patients with low autonomic physiological reserves and high risk of poor post-operative course.

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“…In conclusion, reactivity to and recovery from psychological stressors, across cardiovascular and autonomic systems, represent stable individual traits in healthy individuals, appearing to be, in the current analyses, little influenced by sex and age. Altered physiological responses (both hyper-and hyporeactivity) to acute psychological or physical challenges have been associated with poorer cardiovascular health outcomes over various follow-up periods (Chida & Steptoe, 2010;de Rooij, 2012;Deschamps et al, 2013;Lovallo, 2011). There is already research showing the effectiveness of stress management approaches in improving health outcomes in individuals with CVD (Hagins, States, Selfe, & Innes, 2013;Lehrer et al, 2003).…”

Section: Three-year Stability Of Stress Responsesmentioning

confidence: 99%

Three‐year stability of cardiovascular and autonomic nervous system responses to psychological stress

et al. 2014

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Chronically heightened physiological reactivity to or delayed recovery from stress may contribute to cardiovascular (CV) risk and mortality. Long-term stability of physiological stress responses has received little attention. Our objectives were to evaluate the 3-year stability of reactivity and recovery change scores across CV and autonomic parameters and assess whether sex and age moderate stability. A total of 134 healthy participants underwent two laboratory stress protocols, including four 5-min interpersonal stressors, each followed by a 5-min recovery period. Heart rate (HR), blood pressure (BP), and HR variability (high frequency, low frequency, very low frequency [VLF]) were obtained. Spearman rank correlations and linear regressions were performed. Significant correlations emerged for all physiological measures except diastolic BP and VLF recovery. No significant sex or age differences were found. Stress responses represent stable individual traits little affected by sex or age.

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Evaluation of Autonomic Reserves in Cardiac Surgery Patients

Cited by 13 publications

References 44 publications

Baroreflex sensitivity and outcomes following coronary surgery

Baroreflex sensitivity and outcomes following coronary surgery

Role of heart-rate variability in preoperative assessment of physiological reserves in patients undergoing major abdominal surgery

Three‐year stability of cardiovascular and autonomic nervous system responses to psychological stress

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