Stress and autonomic nerve dysfunction monitoring in perioperative gastric cancer patients using a smart device

Abstract

Background Heart rate variability (HRV), a sensitive marker of stress and autonomic nervous disorders, was significantly decreased in cardiovascular disease, inflammation, and surgical injury. However, the effect of radical gastrectomy on HRV parameters needs to be further investigated. Methods A prospective, observational study including 45 consecutive enrolled patients undergoing radical gastrectomy in our enhanced recovery after surgery (ERAS) programs was conducted. Frequency‐ and time‐domain parameters of HRV from 1 day prior to operation to 4 days postoperatively were continuously measured. Meanwhile, plasma cortisol and inflammatory markers were recorded and correlated to HRV parameters. Results Heart rate variability showed a solidly circadian rhythm. Anesthesia severely disturbed HRV parameters, resulting in a reduction of most of the HRV parameters. Frequency‐domain parameter (including VLF) and time‐domain parameters (including the SDNN, SDANN, and triangular index) of HRV demonstrated a significant reduction compared to preoperative values on the postoperative day 1 (Pod1), and these HRV parameters could return to baseline on Pod2 or Pod3, indicating surgical stress and autonomic nerve dysfunction existed in the early postoperative period. Inflammatory biomarkers were significantly elevated on Pod1 and Pod3. Plasma cortisol decreased significantly on Pod1 and Pod3. Both inflammatory biomarkers and plasma cortisol had no significant correlation with HRV parameters. Conclusions Compared with plasma cortisol and inflammation biomarkers, HRV is more sensitive to detect surgical stress and autonomic nervous dysfunction induced by radical gastrectomy in patients with gastric cancer.

The Impact of Perioperative Events on Cancer Recurrence and Metastasis in Patients after Radical Gastrectomy: A Review

“…Therefore, several studies have reported that increased inflammatory indicators, such as the neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and C-reactive protein (CRP), are associated with cancer recurrence and poor prognosis following radical resection in many types of cancer, including GC [ 50 , 67 , 68 ]. When compared with levels before gastrectomy, inflammatory markers, including neutrophil percentage, CRP, procalcitonin (PCT) and plasma cortisol, were significantly increased after surgery [ 69 ]. These clinical findings indicate that gastrectomy and its associated events activate an inflammatory response, resulting in more recurrence after surgery.…”

Orthostatic intolerance after acute mild hypovolemia: incidence, pathophysiologic hemodynamics, and heart-rate variability analysis—a prospective observational cohort study

“…Heart rate variability is the beat-to-beat variability in heart rate, a sensitive marker of altered autonomic function, that is reduced under different stress conditions. 12 , 13 Many studies have reported decreased HRV indices after abdominal, 14 , 15 , 18 orthopedic, 10 and thoracic surgery, 17 , 19 demonstrating impaired autonomic regulation in the early postoperative period. Contrary to these studies, we found no significant changes during sleep in HRV indices of total autonomic power (SDNN, TP-i) after acute mild blood loss, showing an intact autonomic cardiovascular regulation and autonomic capacity, when blood loss is not associated with surgical stress.…”

“…12 , 13 Postoperative autonomic dysfunction with limited autonomic capacity and decreased sympathetic and parasympathetic outflow characterized by decreased HRV indices is a well-described pathophysiologic phenomenon after various major surgeries and is linked to postoperative morbidity and mortality. 10 , 14 – 20 …”

Harnessing interventions during the immediate perioperative period to improve the long-term survival of patients following radical gastrectomy

“…One of the explanations for the lack of effect on long-term outcomes by SNS blockade is that in addition to increased levels of catecholamine, various inflammatory mediators are also abundantly released into circulation during cancer surgery. The levels of inflammatory mediators, including C-reactive protein (CRP), procalcitonin, prostaglandin E2 and plasma cortisol, were elevated significantly after gastrectomy[ 45 , 46 ]. Activation of the inflammatory response plays an important role in residual cancer cell survival and progression through humoral factor release or premetastatic niche establishment[ 47 - 49 ].…”