Prolonged decrease in heart rate variability after elective hip arthroplasty

Abstract

The pattern of postoperative heart rate variability may provide insight into the response of the autonomic nervous system to anaesthesia and surgery. We have obtained spectral (fast Fourier transform) and non-spectral indices of heart rate variability from electrocardiographic recordings, sampled during continuous perioperative Holter monitoring in 15 otherwise healthy patients with an uncomplicated postoperative course, undergoing elective hip arthroplasty with either spinal or general anaesthesia. In both groups, total spectral energy (0.01-1 Hz), low-frequency spectral energy (0.01-0.15 Hz) and high-frequency spectral energy (0.15-0.40 Hz) decreased after surgery to 32% (95% confidence interval (CI) 10.5; P < 0.01), 29% (95% CI 12.5; P < 0.01) and 33% (95% CI 12.5; P < 0.01) of their preoperative values, respectively, and these indices remained suppressed for up to 5 days. Non-spectral indices decreased to a similar extent. These findings indicate a substantial and prolonged postoperative decrease in both parasympathetic and sympathetic influence on the sinus node.

Diminished Circadian Rhythm of Heart Rate Variability After Aortic Surgery Appears to Be Independent of Myocardial Ischemia

“…23) However, bed-rest after surgery could explain why LF/HF decreased postoperatively, which is in accordance with the findings of Marsch, et al 4,10) Conclusions: In summary, our results indicate that diurnal variation of HRV is not preserved after aortic surgery. As this seems to be a general manifestation, we conclude that myocardial ischemia is only one potentially contributing factor.…”

“…[1][2][3] However, impaired HRV has been described postoperatively. 4,5) Furthermore, this autonomic imbalance has been associated with circulatory instability and ventricular dysfunction intra-and postoperatively. 6,7) In addition, it has recently been shown that some HRV indices determined on the first postoperative day after abdominal aortic surgery are independent predictors of complicated recovery.…”

Wavelet transform of heart rate variability to assess autonomic nervous system activity does not predict arousal from general anesthesia

“…In the field of anesthesia, main changes in HRV consist in a decrease beginning at the onset of induction 1 and persisting throughout anesthesia, followed by a progressive recovery during the hours following arousal 2,3 that, however, can last up to six days after surgery. 4 Wavelet transform of HRV allows to precisely assess abrupt changes in ANS activity and balance 5 triggered by different procedures during surgery under general anesthesia.…”

Pharmacologic modulation of autonomic tone: implications for the diabetic patient

“…Interestingly, induction of general anaesthesia is associated with a substantial reduction in HRV [58]. Sedatives, analgesics, and anaesthetics have a negative influence on HRV, presumably through central mechanisms [19].…”