Respiratory sinus arrhythmia during anaesthesia: assessment of respiration related beat-to-beat heart rate variability analysis methods

Abstract

Beat-to-beat heart rate variability analysis is a powerful tool for the diagnosis of neuropathy. Respiration-related heart rate variability (respiratory sinus arrhythmia, RSA) reflects the function of parasympathetic nervous system during spontaneous ventilation while awake. RSA is also claimed to monitor the depth of anaesthesia. Power spectrum analysis or various averaging techniques of the heart rate variability are usually applied. The current literature, however, does not usually interpret the ground rules and limitations of the method used, and this may sometimes lead to erroneous conclusions on the data. The aim of our study was to compare and analyse critically the performance of different methods of evaluating RSA during anaesthesia and positive pressure ventilation. Power spectrum analysis, the root mean square of the successive RR-interval difference (RMSSD), and two respiration related methods, RSA index and average phase RSA, were included in the comparison. To test these methods, 11 patients were anaesthetised with isoflurane and their lungs were ventilated mechanically with a frequency of 6 cycles min-1. Each patient received a bolus dose of atropine (20 micrograms kg-1) during the trial. Electrocardiogram, electroencephalogram and tracheal pressure signal from respirator were recorded and analyses were performed off-line. We demonstrated that general indices, such as RMSSD, may be strongly affected by heart rate level and other non-respiration related variations in heart rate. We also showed that the effect of unwanted fluctuations on RSA can be reduced with respiration dependent beat-to-beat methods. Furthermore we confirmed that in addition to the amplitude, also the pattern of respiratory sinus arrhythmia is of interest: the pattern is reversed in phase compared to spontaneous breathing while awake, as we have shown earlier. To analyse RSA during anaesthesia, we recommend the use of an average phase RSA method based on beat-to-beat variability that shows both the amplitude and pattern of RSA. Finally, no measure of RSA should be used without a presentation of the actual beat-to-beat heart rate curve.

Linear and nonlinear analysis of heart rate variability during propofol anesthesia for short-duration procedures in children

“…Both respiratory rate and tidal volume may influence the amplitude of respiratory sinus arrhythmia and thus HF heart rate power (16,47,48). Neither respiratory rate nor tidal volume was controlled in this study, so it is possible that changes in heart rate HF power or sympathovagal balance (LF/HF ratio) could occur, at least in part, from changes in respiration (1).…”

“…Of the various HRV metrics, respiration-related HRV (e.g., respiratory sinus arrhythmia or high-frequency heart rate power), which reflects parasympathetic nervous system activity during spontaneous ventilation while awake, has been reported to have the most potential as a clinical monitor of depth of anesthesia (1,16,17). A possible drawback to this method is the question of its physiologic meaning during positive pressure ventilation (18) that is often used during general anesthesia.…”

A method for time-domain analysis of respiratory sinus arrhythmia

“…Most studies have used the frequency domain approach, together with programmed breathing, periodic neck suction and other manoeuvres [12,13,14]. Only rarely has the time-domain approach been used [15,16].…”

ANI-моніторинг Для Оцінки Ефективності Варіантів Анестезіологічного Забезпечення Пластичної Хірургії Носа

“…Анестезиолог в клинической практике оценива-ет адекватность анальгезии по гемодинамическим реакциям, слезотечению и повышенному потоотде-лению, а также учитывает интенсивность хирурги-ческой стимуляции [2]. Необходимо отметить, что развитие гемодинамического ответа иногда возни-кает через 5-10 минут после начала ноцицептивной стимуляции, при этом степень выраженности гемо-динамических изменений не всегда соответствует силе ноцицепции [3].…”