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

37 Citations (Scopus)

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

Keywords

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

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