BJA Advance Access originally published online on April 27, 2007
British Journal of Anaesthesia 2007 98(6):728-736; doi:10.1093/bja/aem085
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Heart rate variability does not discriminate between different levels of haemodynamic responsiveness during surgical anaesthesia
1 Department of Anaesthesiology, University Hospital of Bern, University of Bern, Bern, Switzerland
2 VTT Technical Research Centre of Finland, Tampere, Finland
* Corresponding author: Department of Anaesthesiology, University Hospital, CH-3010 Bern, Switzerland. E-mail: martin.luginbuehl{at}dkf.unibe.ch
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.
Keywords: anaesthetics i.v., propofol; analgesics opioid, remifentanil; heart, heart rate variability; monitoring, bispectral index; Poincaré analysis
The data were presented in part at the annual meeting of the European Society of Anaesthesiologists June 5–8, 2004, in Lisbon.
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