Changes in heart rate variability in sevoflurane and nitrous oxide anesthesia: Effects of respiration and depth of anesthesia
Changes in heart rate variability in sevoflurane and nitrous oxide anesthesia: Effects of respiration and depth of anesthesia
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DOI：
10.1016/s0952-8180(01)00384-1
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发表时间：
2002-05-01
影响因子：
6.7
通讯作者：
Takeda, J
中科院分区：
文献类型：
--
作者：
Nakatsuka, I;Ochiai, R;Takeda, J
研究目的：通过分析七氟烷麻醉中心率（HR）变异性的变化，量化七氟烷对自主神经功能的影响;并研究麻醉深度和呼吸暂停对HR变异性的影响。设计：前瞻性研究。设置：大学医学中心的手术室（OR）。患者：7名阿萨身体状态I和II的择期手术患者。干预措施：患者术前给予雷尼替丁150 mg。麻醉诱导硫喷妥钠4 mg/kg静脉注射（IV）和琥珀酰胆碱1 mg/hg静脉注射，并维持与一氧化二氮（N2 O）67%和七氟烷在氧气。患者以15次/min的速率机械通气。测量：记录心电图（ECG）、脑电图（EEG）的R-R间期、无创动脉血压（BP）和呼气末七氟醚浓度。1）在患者到达手术室并以仰卧位放置后，2）吸入2%七氟烷后稳定期，3）在较高浓度七氟烷出现等电EEG后进行测量。在时间2）和3），在机械通气期间和呼吸暂停期间记录数据。主要结果：与清醒状态相比，麻醉期间HR变异性的低频（LE; 0.04至0.15 Hz）和高频（HF; 0.15至0.4 Hz）分量均降低。在2%七氟烷时，HF在呼吸暂停期间降低，但LF没有变化。LF和I-IF均未随等电EEG中呼吸的存在或不存在而改变。结论：七氟醚可减弱自主神经活动。通过呼吸向心脏的副交感神经输入在等电位EEG出现后被显著抑制。(C)2002年，Elsevier Science Inc.
Study Objective: To quantify the effects of sevoflurane on autonomic nerve function by analyzing changes in heart rate (HR) variability in sevoflurane anesthesia; and to investigate the effects of anesthetic depth and apnea on HR variability.Design: Prospective study.Setting: Operating room (OR) of a university medical center.Patients: 7 ASA physical status I and II patients scheduled for elective surgery.Interventions: Patients were premedicated with ranitidine 150 mg. Anesthesia was induced with thiopental sodium 4 mg/kg intravenously (IV) and succinylchozine 1 mg/hg IV, and maintained with nitrous oxide (N2O) 67% and sevoflurane in oxygen. Patients were ventilated mechanically at a rate of 15 breaths/min.Measurements: R-R interval of electrocardiography (ECG), electroencephalogram (EEG), noninvasive arterial blood pressure (BP), and end-tidal sevoflurane concentration were recorded. Measurements were performed 1) after patients arrived at the OR and were placed in the supine position, 2) a stable period after inhalation of 2% sevoflurane, and 3) following the appearance of an isoelectric EEG at a higher concentration of sevoflurane. At times 2) and 3), data were recorded during mechanical ventilation and during apnea. Main Results: There were decreases in both the low-frequency (LE; 0.04 to 0.15 Hz) and high-frequency (HF; 0.15 to 0.4 Hz) components of HR variability during anesthesia compared with the awake state. HF decreased during apnea at 2% sevoflurane, but LF did not change. Neither LF nor I-IF changed in response to the absence or presence of respiration during isoelectric EEG.Conclusions: Autonomic nerve activity was attenuated by sevoflurane. Parasympathetic input to the heart by respiration was markedly suppressed following the appearance of isoelectric EEG. (C) 2002 by Elsevier Science Inc.