Heart rate variability does not discriminate between different levels of haemodynamic responsiveness during surgical anaesthesia

Martin Luginbühl (Corresponding Author), Heidi Yppärilä-Wolters, Mathias Rüfenacht, Stefan Petersen-Felix, Ilkka Korhonen

Research output: Contribution to journalArticleScientificpeer-review

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Abstract

Background Hypnotic depth but not haemodynamic responsiveness is measured with EEG-based monitors. In this study we compared heart rate variability (HRV) in unstimulated patients and stimulation-induced HRV at different levels of anaesthesia. Methods A total of 95 ASA I or II patients were randomly assigned to five groups (Group 1: BIS 45(5), remifentanil 1 ng ml-1; Group 2: BIS 45(5), remifentanil 2 ng ml-1; Group 3: BIS 45(5), remifentanil 4 ng ml-1; Group 4: BIS 30(5), remifentanil 2 ng ml-1; Group 5: BIS 60(5), remifentanil 2 ng ml-1). A time- and frequency-domain analysis of the RR interval (RRI) from the electrocardiogram was performed. HRV before induction, before and after a 5 s tetanic stimulus of the ulnar nerve, and before and after tracheal intubation was compared between groups, between stimuli, and between responders to intubation [systolic arterial pressure (SAP) increase >20 mm Hg, a maximal heart rate (HR) after intubation >90 min-1 or both] and non-responders (anova). Results Induction of anaesthesia significantly lowered HR and HRV. Mean RRI before stimulation was higher in G3 than in G1, G2, and G4 (P < 0.001), whereas the other HRV parameters were similar. Intubation induced a greater HRV response than tetanic stimulation. The mean RRI after intubation was lower in G3 compared with the other groups and the sd of the RRI after tetanic stimulation was lower in G3 compared with G5. Otherwise, unstimulated HRV and stimulation-induced HRV were similar in responders and non-responders. Conclusion HRV parameters discriminate between awake and general anaesthesia, are different after tracheal intubation and a 5 s ulnar nerve stimulation, but do not discriminate between different levels of haemodynamic responsiveness during surgical anaesthesia.
Original languageEnglish
Pages (from-to)728-736
JournalBritish Journal of Anaesthesia
Volume98
Issue number6
DOIs
Publication statusPublished - 2007
MoE publication typeA1 Journal article-refereed

Fingerprint

Anesthesia
Heart Rate
Hemodynamics
Intubation
Ulnar Nerve
Hypnotics and Sedatives
General Anesthesia
Electroencephalography
Arterial Pressure
Electrocardiography
remifentanil
Blood Pressure

Keywords

  • anaesthetics i.v., propofol
  • analgesics opioid, remifentanil
  • heart, heart rate variability
  • monitoring, bispectral index
  • Poincare´ analysis

Cite this

Luginbühl, Martin ; Yppärilä-Wolters, Heidi ; Rüfenacht, Mathias ; Petersen-Felix, Stefan ; Korhonen, Ilkka. / Heart rate variability does not discriminate between different levels of haemodynamic responsiveness during surgical anaesthesia. In: British Journal of Anaesthesia. 2007 ; Vol. 98, No. 6. pp. 728-736.
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title = "Heart rate variability does not discriminate between different levels of haemodynamic responsiveness during surgical anaesthesia",
abstract = "Background Hypnotic depth but not haemodynamic responsiveness is measured with EEG-based monitors. In this study we compared heart rate variability (HRV) in unstimulated patients and stimulation-induced HRV at different levels of anaesthesia. Methods A total of 95 ASA I or II patients were randomly assigned to five groups (Group 1: BIS 45(5), remifentanil 1 ng ml-1; Group 2: BIS 45(5), remifentanil 2 ng ml-1; Group 3: BIS 45(5), remifentanil 4 ng ml-1; Group 4: BIS 30(5), remifentanil 2 ng ml-1; Group 5: BIS 60(5), remifentanil 2 ng ml-1). A time- and frequency-domain analysis of the RR interval (RRI) from the electrocardiogram was performed. HRV before induction, before and after a 5 s tetanic stimulus of the ulnar nerve, and before and after tracheal intubation was compared between groups, between stimuli, and between responders to intubation [systolic arterial pressure (SAP) increase >20 mm Hg, a maximal heart rate (HR) after intubation >90 min-1 or both] and non-responders (anova). Results Induction of anaesthesia significantly lowered HR and HRV. Mean RRI before stimulation was higher in G3 than in G1, G2, and G4 (P < 0.001), whereas the other HRV parameters were similar. Intubation induced a greater HRV response than tetanic stimulation. The mean RRI after intubation was lower in G3 compared with the other groups and the sd of the RRI after tetanic stimulation was lower in G3 compared with G5. Otherwise, unstimulated HRV and stimulation-induced HRV were similar in responders and non-responders. Conclusion HRV parameters discriminate between awake and general anaesthesia, are different after tracheal intubation and a 5 s ulnar nerve stimulation, but do not discriminate between different levels of haemodynamic responsiveness during surgical anaesthesia.",
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author = "Martin Luginb{\"u}hl and Heidi Ypp{\"a}ril{\"a}-Wolters and Mathias R{\"u}fenacht and Stefan Petersen-Felix and Ilkka Korhonen",
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Heart rate variability does not discriminate between different levels of haemodynamic responsiveness during surgical anaesthesia. / Luginbühl, Martin (Corresponding Author); Yppärilä-Wolters, Heidi; Rüfenacht, Mathias; Petersen-Felix, Stefan; Korhonen, Ilkka.

In: British Journal of Anaesthesia, Vol. 98, No. 6, 2007, p. 728-736.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Heart rate variability does not discriminate between different levels of haemodynamic responsiveness during surgical anaesthesia

AU - Luginbühl, Martin

AU - Yppärilä-Wolters, Heidi

AU - Rüfenacht, Mathias

AU - Petersen-Felix, Stefan

AU - Korhonen, Ilkka

N1 - Project code: 1305

PY - 2007

Y1 - 2007

N2 - Background Hypnotic depth but not haemodynamic responsiveness is measured with EEG-based monitors. In this study we compared heart rate variability (HRV) in unstimulated patients and stimulation-induced HRV at different levels of anaesthesia. Methods A total of 95 ASA I or II patients were randomly assigned to five groups (Group 1: BIS 45(5), remifentanil 1 ng ml-1; Group 2: BIS 45(5), remifentanil 2 ng ml-1; Group 3: BIS 45(5), remifentanil 4 ng ml-1; Group 4: BIS 30(5), remifentanil 2 ng ml-1; Group 5: BIS 60(5), remifentanil 2 ng ml-1). A time- and frequency-domain analysis of the RR interval (RRI) from the electrocardiogram was performed. HRV before induction, before and after a 5 s tetanic stimulus of the ulnar nerve, and before and after tracheal intubation was compared between groups, between stimuli, and between responders to intubation [systolic arterial pressure (SAP) increase >20 mm Hg, a maximal heart rate (HR) after intubation >90 min-1 or both] and non-responders (anova). Results Induction of anaesthesia significantly lowered HR and HRV. Mean RRI before stimulation was higher in G3 than in G1, G2, and G4 (P < 0.001), whereas the other HRV parameters were similar. Intubation induced a greater HRV response than tetanic stimulation. The mean RRI after intubation was lower in G3 compared with the other groups and the sd of the RRI after tetanic stimulation was lower in G3 compared with G5. Otherwise, unstimulated HRV and stimulation-induced HRV were similar in responders and non-responders. Conclusion HRV parameters discriminate between awake and general anaesthesia, are different after tracheal intubation and a 5 s ulnar nerve stimulation, but do not discriminate between different levels of haemodynamic responsiveness during surgical anaesthesia.

AB - Background Hypnotic depth but not haemodynamic responsiveness is measured with EEG-based monitors. In this study we compared heart rate variability (HRV) in unstimulated patients and stimulation-induced HRV at different levels of anaesthesia. Methods A total of 95 ASA I or II patients were randomly assigned to five groups (Group 1: BIS 45(5), remifentanil 1 ng ml-1; Group 2: BIS 45(5), remifentanil 2 ng ml-1; Group 3: BIS 45(5), remifentanil 4 ng ml-1; Group 4: BIS 30(5), remifentanil 2 ng ml-1; Group 5: BIS 60(5), remifentanil 2 ng ml-1). A time- and frequency-domain analysis of the RR interval (RRI) from the electrocardiogram was performed. HRV before induction, before and after a 5 s tetanic stimulus of the ulnar nerve, and before and after tracheal intubation was compared between groups, between stimuli, and between responders to intubation [systolic arterial pressure (SAP) increase >20 mm Hg, a maximal heart rate (HR) after intubation >90 min-1 or both] and non-responders (anova). Results Induction of anaesthesia significantly lowered HR and HRV. Mean RRI before stimulation was higher in G3 than in G1, G2, and G4 (P < 0.001), whereas the other HRV parameters were similar. Intubation induced a greater HRV response than tetanic stimulation. The mean RRI after intubation was lower in G3 compared with the other groups and the sd of the RRI after tetanic stimulation was lower in G3 compared with G5. Otherwise, unstimulated HRV and stimulation-induced HRV were similar in responders and non-responders. Conclusion HRV parameters discriminate between awake and general anaesthesia, are different after tracheal intubation and a 5 s ulnar nerve stimulation, but do not discriminate between different levels of haemodynamic responsiveness during surgical anaesthesia.

KW - anaesthetics i.v., propofol

KW - analgesics opioid, remifentanil

KW - heart, heart rate variability

KW - monitoring, bispectral index

KW - Poincare´ analysis

U2 - 10.1093/bja/aem085

DO - 10.1093/bja/aem085

M3 - Article

VL - 98

SP - 728

EP - 736

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

SN - 0007-0912

IS - 6

ER -