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Heart rate variability and oxygen reserve index during cardiorespiratory events in patients undergoing ophthalmic arterial chemotherapy: a prospective observational study

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Abstract

Unexpected cardiorespiratory compromise has been reported during ophthalmic arterial chemotherapy in pediatric patients with retinoblastoma. Although the underlying mechanisms remain unclear, autonomic responses are presumed to contribute to these events. We hypothesized that periprocedural heart rate variability would differ between patients with and without events. Between April 2018 and September 2019, 38 patients (age under 7 years) were included. Heart rate variability was analyzed using electrocardiogram, and oxygen reserve index was also monitored. Cardiorespiratory events were defined as > 30% changes in blood pressure or heart rate, > 20% changes in end-tidal carbon dioxide, > 40% changes in peak inspiratory pressure, or pulse oxygen saturation < 90% during ophthalmic artery catheterization. Heart rate variability and oxygen reserve index were compared between patients with and without cardiorespiratory events. Cardiorespiratory events occurred in 13/38 (34%) patients. During the events, end-tidal carbon dioxide was significantly lower (median difference [95% CI], − 2 [− 4 to − 1] mmHg, p = 0.006) and the maximum peak inspiratory pressure was higher (30 [25–37] vs. 15 [14–16] hPa, p < 0.001), compared to patients without events. Standard deviation of normal-to-normal R–R interval, total power, and very low-frequency power domain increased during selection of the ophthalmic artery in patients with events (all adjusted p < 0.0001), without predominancy of specific autonomic nervous alterations. Oxygen reserve index was significantly lower in patients with events than those without throughout the procedure (mean difference [95% CI], − 0.19 [− 0.32 to − 0.06], p = 0.005). Enhanced compensatory autonomic regulation without specific autonomic predominancy, and reduced oxygen reserve index was observed in patients with cardiorespiratory events than in patients without events.

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Data availability

The dataset used and analyzed in the present study is available from the corresponding author on request.

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Acknowledgements

We thank to the Medical Research Collaborating Center for their advice concerning the statistical analyses.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Author notes

  1. Tae Kyong Kim

    Present address: Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, South Korea

Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea

    Youn Joung Cho, Karam Nam, Hyung-Chul Lee, Yunseok Jeon & Tae Kyong Kim

  2. Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, South Korea

    Dhong-Eun Jung

  3. Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea

    Yoomin Oh

  4. Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea

    Young Dae Cho

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  1. Youn Joung Cho
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Contributions

Concept and design—YDC, TKK. Acquisition, analysis, or interpretation of data—D-EJ, YO, H-CL. Drafting of the manuscript—YJC. Critical revision of the manuscript for important intellectual content and final approval—all authors. Statistical analysis—YJ, YDC, TKK. Administrative, technical, or material support—H-CL, YJ, YDC. Study supervision—YJC, TKK.

Corresponding author

Correspondence to Tae Kyong Kim.

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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 from the parents or legal guardians of all participating pediatric patients in the study.

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Cho, Y.J., Jung, DE., Oh, Y. et al. Heart rate variability and oxygen reserve index during cardiorespiratory events in patients undergoing ophthalmic arterial chemotherapy: a prospective observational study. J Clin Monit Comput 36, 557–567 (2022). https://doi.org/10.1007/s10877-021-00687-z

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  • DOI: https://doi.org/10.1007/s10877-021-00687-z

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