Heart rate variability during total intravenous anesthesia: Effects of nociception and analgesia
Heart rate variability during total intravenous anesthesia: Effects of nociception and analgesia
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DOI：
10.1016/j.autneu.2009.01.005
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发表时间：
2009-05-11
影响因子：
2.7
通讯作者：
Tavernier, Benoit
中科院分区：
文献类型：
--
作者：
Jeanne, Mathieu;Logier, Regis;Tavernier, Benoit
背景：麻醉期间心率变异性（HRV）的变化可能是催眠相互作用的结果。手术刺激、镇痛和药物的直接心血管效应，但这些变量之间的相互作用尚不清楚。本研究旨在描述手术伤害感受和镇痛对丙泊酚麻醉患者HRV的影响。应用小波变换对49例患者的心率变异性进行分析（ASA状态1 - 2）麻醉诱导前，然后在无伤害性刺激的情况下，在丙泊酚稳定麻醉期间，然后在手术期间，在深的存在（足够）或轻各种阿片类药物提供的（不充分）镇痛舒芬太尼[n = 19]、阿芬太尼[n = 18]或瑞芬太尼[n = 12]。麻醉降低了总功率以及高频（HF）和低频（LF）功率（均：P <0.01），高频功率比例部分（HFnu）增加（P = 0.002）。在疼痛过程中，HFnu在轻度镇痛时以敏感且可重复的方式降低（P <0.01），而在充分镇痛时HRV无明显变化。HFnu可能表现为镇痛不足的早期指标。这些结果对监测静脉麻醉健康患者的镇痛充分性具有潜在的意义。在患者人群中的应用需要额外的工作。(c)2009爱思唯尔有限公司版权所有。
Background: Changes in heart rate variability (HRV) during anesthesia likely result from the interaction of hypnosis. surgical stimulation, analgesia and direct cardiovascular effects of drugs, but the interaction between these variables is unclear. This study was designed to characterize the impact of both surgical nociception and analgesia on HRV in propofol-anesthetized patients.Methods: HRV was analyzed using wavelet transform in 49 patients (ASA status 1-2) before induction of anesthesia and then throughout stable anesthesia with propofol, in the absence of nociceptive stimulation, and then during surgery, in the presence of deep (adequate) or light (inadequate) analgesia provided by various opioids (sufentanil [n = 19], alfentanil [n = 18], or remifentanil [n = 12].Results: Anesthesia reduced total power as well as high frequency (HF) and low frequency (LF) powers (all: P < 0.01), with an increase (P=0.002) in the proportional part of HF power (HFnu). During nociception, HFnu decreased in a sensitive and reproducible way (P < 0.01) in case of light analgesia, whereas HRV did not change when patient received adequate analgesia.Conclusions: The nociception-analgesia balance is a direct determinant of HRV during surgical anesthesia. HFnu may behave like an early indicator of inadequate analgesia. These results have potential implication for monitoring adequacy of analgesia in healthy patients undergoing intravenous anesthesia. Additional work is needed for application across patient populations. (c) 2009 Elsevier B.V. All rights reserved.