Journal of Clinical Monitoring and Computing

, Volume 27, Issue 4, pp 417–426 | Cite as

Baroreflex sensitivity variations in response to propofol anesthesia: comparison between normotensive and hypertensive patients

  • Guadalupe Dorantes Mendez
  • Federico Aletti
  • Nicola Toschi
  • Antonio Canichella
  • Mario Dauri
  • Filadelfo Coniglione
  • Maria Guerrisi
  • Maria G. Signorini
  • Sergio Cerutti
  • Manuela Ferrario
Original Research

Abstract

The aim of this paper is to compare baroreflex sensitivity (BRS) following anesthesia induction via propofol to pre-induction baseline values through a systematic and mathematically robust analysis. Several mathematical methods for BRS quantification were applied to pre-operative and intra-operative data collected from patients undergoing major surgery, in order to track the trend in BRS variations following anesthesia induction, as well as following the onset of mechanical ventilation. Finally, a comparison of BRS trends in chronic hypertensive patients (CH) with respect to non hypertensive (NH) patients was performed. 10 NH and 7 CH patients undergoing major surgery with American Society of Anesthesiologists classification score 2.5 ± 0.5 and 2.6 ± 0.5 respectively, were enrolled in the study. A Granger causality test was carried out to verify the causal relationship between RR interval duration and systolic blood pressure (SBP), and four different mathematical methods were used to estimate the BRS: (1) ratio between autospectra of RR and SBP, (2) transfer function, (3) sequence method and (4) bivariate closed loop model. Three different surgical epochs were considered: baseline, anesthetic procedure and post-intubation. In NH patients, propofol administration caused a decrease in arterial blood pressure (ABP), due to its vasodilatory effects, and a reduction of BRS, while heart rate (HR) remained unaltered with respect to baseline values before induction. A larger decrease in ABP was observed in CH patients when compared to NH patients, whereas HR remained unaltered and BRS was found to be lower than in the NH group at baseline, with no significant changes in the following epochs when compared to baseline. To our knowledge, this is the first study in which the autonomic response to propofol induction in CH and NH patients was compared. The analysis of BRS through a mathematically rigorous procedure in the perioperative period could result in the availability of additional information to guide therapy and anesthesia in uncontrolled hypertensive patients, which are prone to a higher rate of hypotension events occurring during general anesthesia induction.

Keywords

Baroreflex sensitivity Causality Anesthesia Blood pressure Heart rate 

Abbreviations

HR

Heart rate

SBP

Systolic blood pressure

DBP

Diastolic blood pressure

ABP

Arterial blood pressure

BR

Baroreflex

BRS

Baroreflex sensitivity

TF

Transfer function method

LF

Low frequency

HF

High frequency

TP

Total power

CH

Chronic hypertensive

NH

Non hypertensive

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Guadalupe Dorantes Mendez
    • 1
  • Federico Aletti
    • 1
  • Nicola Toschi
    • 2
  • Antonio Canichella
    • 2
  • Mario Dauri
    • 3
  • Filadelfo Coniglione
    • 3
  • Maria Guerrisi
    • 2
  • Maria G. Signorini
    • 1
  • Sergio Cerutti
    • 1
  • Manuela Ferrario
    • 1
  1. 1.Department of BioengineeringPolitecnico di MilanoMilanItaly
  2. 2.Medical Physics Section, Faculty of MedicineUniversity of Rome “Tor Vergata”RomeItaly
  3. 3.Department of Anesthesia and Intensive Care Medicine, Faculty of MedicineUniversity of Rome “Tor Vergata”RomeItaly

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