Preoperative heart rate variability analysis is as a potential simple and easy measure for predicting perioperative delirium in esophageal surgery

Abstract

Background Delirium is one of the most common but severe perioperative complications. Autonomic activity evaluated by heart rate variability (HRV) has been recently reported as a useful tool for prediction and for early detection of delirium in acute care medicine, especially in postoperative intensive care unit (ICU) patients. We hypothesized that HRV, by 3-lead electrocardiogram (ECG), one day prior to surgery might correlate with the presence of postoperative delirium. Materials and methods This study was cohort prospective pilot study. We measured preoperative HRV and postoperative delirium in patients who underwent surgery for elective esophageal cancer. ECG of the participants was performed for 10 min 6–12 h preceding surgery. Postoperatively, patients were admitted to the ICU or critical care unit and stayed for at least 3 days. Delirium was diagnosed by psychiatrist rounds twice a day. Results Delirium was assessed for 3 days after surgery and 30 patients performed the study. Seven patients developed delirium during their ICU stay, while the remaining twenty-three did not. After HRV analysis, the preoperative high frequency power in delirium patients was significantly lower than that in non-delirium patient. Other parameters of HRV, including lower frequency power, total power and the ratio showed no statistically significant difference between the groups. Conclusion The results of current study demonstrated that preoperative measurement of HRV may be a useful predictor of delirium. Further investigation could pave the way to a non-invasive, minimally stressful method of predicting postoperative delirium.

Predicting Postoperative Emergence Delirium From the Heart Rate Variability of Patients Undergoing Elective Cardiac Surgery

“…We previously reported that preoperative HF is correlated with postoperative delirium in patients undergoing radical surgery for esophageal cancer [ 8 ]. The surgery for esophageal cancer is long and highly invasive, and the incidence of postoperative delirium was 23% [ 8 ]. A short-term preoperative HRV consistently predicts postoperative delirium across facilities and surgical sites.…”

“…In this study, delirium was diagnosed by CAM-ICU and not based on questionnaires from a psychiatrist. In the previous paper, we investigated the relationship between postoperative delirium and HRV in esophageal cancer surgery in the ICU, and delirium was diagnosed by psychiatrists [ 8 ]. Although this method is more popular because the ICU nurses evaluate during their working hours, unlike a psychiatrist's diagnosis, there is a high likelihood of overlooking low activity and reduced judgment accuracy [ 21 ].…”

“…In our previous study, we investigated the occurrence of postoperative delirium after esophageal cancer surgery and whether it can be predicted by heart rate variability (HRV). And we reported that a decrease in the high-frequency (HF) component of HRV on the day before surgery may predict delirium [ 8 ]. Based on this finding, we proposed that if postoperative delirium can be predicted by the non-invasive short-term analysis of HRV, it could be used for the more efficient allocation of limited medical resources.…”

Association between preoperative atrial fibrillation and postoperative delirium in patients with pulmonary hypertension: A secondary analysis of a retrospective cohort study

“…Another heart rate variability analysis found that preoperative high-frequency power was signi cantly lower in delirium patients than in non-delirium patients. Preoperative measurement of heart rate variability may be a useful predictor of delirium [31] . Therefore, abnormal autonomic activity may also be one of the mechanisms of postoperative delirium.…”

Changes in Postoperative Analgesia

“…New sleep medications, ramelteon and suvorexant, have also been reported to have preventive and therapeutic effects [35][36][37] and are increasingly prescribed on regular basis rather than as-needed. At our institution, we hypothesized that heart-rate variability could be used to predict delirium, and we have found that changes in autonomic nerves on the day before surgery can help predict delirium [38].…”