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Low pre-operative heart rate variability and complexity are associated with hypotension after anesthesia induction in major abdominal surgery

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Abstract

Significant hypotension after induction of general anesthesia is common and has the potential for serious complications. This study aimed to determine if pre-operative heart rate variability (HRV) was associated with post-induction hypotension in patients undergoing major abdominal surgery. Patients undergoing semi-elective major abdominal surgery were consecutively recruited during pre-admission clinic assessment. Exclusion criteria included cardiac conduction disease, arrhythmias or severe liver or renal disease. Ten minutes of electrocardiogram at 1024 Hz were recorded a median of 3 days pre-operatively. Pre-operative HRV parameters were compared in patients who experienced significant hypotension (fall in systolic and mean arterial pressure (MAP) >30% baseline and MAP ≤60 mmHg) versus those who remained haemodynamically stable after induction of general anesthesia with propofol and fentanyl. Patients who experienced hypotension after general anesthesia induction had significantly lower pre-operative HRV (SDNN 16 vs. 37 ms, p < 0.001), reduced spectral power (total power 262 vs. 1236 ms2, p = 0.002) and reduced correlation dimension, a measure of signal complexity (0.11 vs. 2.13, p < 0.001). Hypotension occurred relatively frequently in our cohort and was associated with a higher ASA grade (36 vs. 6% ASA 3, p = 0.036), hence post-induction hypotension and lower HRV may be associated with severity of illness or poor physiological reserve. Pre-operative HRV was a useful screening tool in identifying patients undergoing major abdominal surgery who were at risk of haemodynamic instability after anesthesia induction.

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References

  1. Reich DL, Hossain S, Krol M, Baez B, Patel P, Bernstein A, Bodian CA. Predictors of hypotension after induction of general anesthesia. Anesth Analg. 2005;101:622–8.

    Article  PubMed  Google Scholar 

  2. Walsh M, Devereaux PJ, Garg AX, Kurz A, Turan A, Rodseth RN, Cywinski J, Thabane L, Sessler DI. Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery: toward an empirical definition of hypotension. Anesthesiology. 2013;119:507–15.

    Article  PubMed  Google Scholar 

  3. Willingham MD, Karren E, Shanks AM, O’Connor MF, Jacobsohn E, Kheterpal S, Avidan MS. Concurrence of intraoperative hypotension, low minimum alveolar concentration, and low bispectral index is associated with postoperative death. Anesthesiology. 2015;123:775–85.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Burgos LG, Ebert TJ, Asiddao C, Turner LA, Pattison CZ, Wang-Cheng R, Kampine JP. Increased intraoperative cardiovascular morbidity in diabetics with autonomic neuropathy. Anesthesiology. 1989;70:591–7.

    Article  CAS  PubMed  Google Scholar 

  5. Huang CJ, Kuok CH, Kuo TB, Hsu YW, Tsai PS. Pre-operative measurement of heart rate variability predicts hypotension during general anesthesia. Acta Anaesthesiol Scand. 2006;50:542–8.

    Article  PubMed  Google Scholar 

  6. Coriat P, Richer C, Douraki T, Gomez C, Hendricks K, Giudicelli JF, Viars P. Influence of chronic angiotensin-converting enzyme inhibition on anesthetic induction. Anesthesiology. 1994;81:299–307.

    Article  CAS  PubMed  Google Scholar 

  7. Schubert A, Palazzolo JA, Brum JM, Ribeiro MP, Tan M. Heart rate, heart rate variability, and blood pressure during perioperative stressor events in abdominal surgery. J Clin Anesth. 1997;9:52–60.

    Article  CAS  PubMed  Google Scholar 

  8. Latson TW, Ashmore TH, Reinhart DJ, Klein KW, Giesecke AH. Autonomic reflex dysfunction in patients presenting for elective surgery is associated with hypotension after anesthesia induction. Anesthesiology. 1994;80:326–37.

    Article  CAS  PubMed  Google Scholar 

  9. Hanss R, Renner J, Ilies C, Moikow L, Buell O, Steinfath M, Scholz J, Bein B. Does heart rate variability predict hypotension and bradycardia after induction of general anaesthesia in high risk cardiovascular patients? Anaesthesia. 2008;63:129–35.

    Article  CAS  PubMed  Google Scholar 

  10. Keyl C, Lemberger P, Palitzsch KD, Hochmuth K, Liebold A, Hobbhahn J. Cardiovascular autonomic dysfunction and hemodynamic response to anesthetic induction in patients with coronary artery disease and diabetes mellitus. Anesth Analg. 1999;88:985–91.

    Article  CAS  PubMed  Google Scholar 

  11. Chamchad D, Arkoosh VA, Horrow JC, Buxbaum JL, Izrailtyan I, Nakhamchik L, Hoyer D, Kresh JY. Using heart rate variability to stratify risk of obstetric patients undergoing spinal anesthesia. Anesth Analg. 2004;99:1818–21.

    Article  PubMed  Google Scholar 

  12. Tarvainen MP, Niskanen JP, Lipponen JA, Ranta-Aho PO, Karjalainen PA. Kubios HRV—heart rate variability analysis software. Comput Methods Programs Biomed. 2014;113:210–20.

    Article  PubMed  Google Scholar 

  13. Hanss R, Bein B, Ledowski T, Lehmkuhl M, Ohnesorge H, Scherkl W, Steinfath M, Scholz J, Tonner PH. Heart rate variability predicts severe hypotension after spinal anesthesia for elective cesarean delivery. Anesthesiology. 2005;102:1086–93.

    Article  PubMed  Google Scholar 

  14. Hanss R, Bein B, Francksen H, Scherkl W, Bauer M, Doerges V, Steinfath M, Scholz J, Tonner P. Heart rate variability-guided prophylactic treatment of severe hypotension after subarachnoid block for elective cesarean delivery. Anesthesiology. 2006;104:635–43.

    Article  PubMed  Google Scholar 

  15. Laitio T, Jalonen J, Kuusela T, Scheinin H. The role of heart rate variability in risk stratification for adverse postoperative cardiac events. Anesth Analg. 2007;105:1548–60.

    Article  PubMed  Google Scholar 

  16. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology (1996) Heart rate variability: standards of measurement, physiological interpretation, and clinical use. Circulation 93:1043–65.

    Article  Google Scholar 

  17. Fujiwara Y, Kurokawa S, Asakura Y, Wakao Y, Nishiwaki K, Komatsu T. Correlation between heart rate variability and hemodynamic fluctuation during induction of general anaesthesia: comparison between linear and non-linear analysis. Anaesthesia. 2007;62:117–21.

    Article  CAS  PubMed  Google Scholar 

  18. Elghozi JL, Julien C. Sympathetic control of short-term heart rate variability and its pharmacological modulation. Fundam Clin Pharmacol. 2007;21:337–47.

    Article  CAS  PubMed  Google Scholar 

  19. Jelenova D, Ociskova M, Prasko J, et al. Heart rate variability in children with inflammatory bowel diseases. Neuro Endocrinol Lett. 2015;36:72–9.

    PubMed  Google Scholar 

  20. Cramer L, Hildebrandt B, Kung T, et al. Cardiovascular function and predictors of exercise capacity in patients with colorectal cancer. J Am Coll Cardiol. 2014;64:1310–9.

    Article  PubMed  Google Scholar 

  21. Keet SW, Bulte CS, Boer C, Bouwman RA. Reproducibility of non-standardized autonomic function testing in the pre-operative assessment screening clinic. Anaesthesia. 2011;66:10–4.

    Article  CAS  PubMed  Google Scholar 

  22. Haney MF, Wiklund U. Can heart rate variability become a screening tool for anesthesia-related hypotension? Acta Anaesthesiol Scand. 2007;51:1289–91.

    Article  CAS  PubMed  Google Scholar 

  23. Filipovic M, Jeger RV, Girard T, Probst C, Pfisterer M, Gürke L, Studer W, Seeberger MD. Predictors of long-term mortality and cardiac events in patients with known or suspected coronary artery disease who survive major non-cardiac surgery. Anaesthesia. 2005;60:5–11.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The authors gratefully acknowledge the following people for their assistance with patient recruitment (Jenny Stevens and Matthew Ho), data collection (Darren Rutgers) and acquisition of Holter monitors (Adam Hill and Jamie Vandenberg).

Funding

This study was not funded by external grants.

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Authors and Affiliations

  1. Department of Anaesthesia, St Vincent’s Hospital, 390 Victoria St, Darlinghurst, NSW, 2010, Australia

    James R. Padley & Erez Ben-Menachem

  2. Notre Dame School of Medicine, Darlinghurst, NSW, Australia

    Erez Ben-Menachem

Authors
  1. James R. Padley
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  2. Erez Ben-Menachem
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Correspondence to James R. Padley.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Written informed consent was obtained by all individual participants in this study.

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Padley, J.R., Ben-Menachem, E. Low pre-operative heart rate variability and complexity are associated with hypotension after anesthesia induction in major abdominal surgery. J Clin Monit Comput 32, 245–252 (2018). https://doi.org/10.1007/s10877-017-0012-4

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  • DOI: https://doi.org/10.1007/s10877-017-0012-4

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