Abstract
Purpose
To observe heart rate (HRV) and blood pressure variability (BPV) as indices of neurocirculatory responses to induced hypotension with diltiazem and/or nicardipine for hip surgery.
Methods
Thirty-six ASA I–II patients received diltiazem (group D, n = 12), nicardipine (group N, n = 12) or combination of diltiazem/nicardipine (group DN, n = 12). The intensity of HRV and BPV was determined by spectral analysis of HRV and BPV before anesthesia (T0), just before induced hypotension (T1), and at 10 and 30 min after the start of induced hypotension (T2 and T3, respectively). The logarithmic HRV and BPV were integrated: sympathetic and parasympathetic mediated low frequency area (0.06–0.1 Hz, LF), parasympathetic related high frequency area (0.15–0.4 Hz, HF) and total frequency area (0.01–0.4 Hz). Blood loss was assessed by weighing gauzes and measuring suction.
Results
Group DN had less blood loss (466 ± 46 ml, mean ± SEM) than group D (733 ± 100 ml,P < 0.05). Diltiazem (11.4 ± 0.9 μg·kg−1·min−1), and combination of diltiazem (0.25 ± 0.01 mg·kg−1) and nicardipine (5.9 ± 0.9 μg·kg−1·min−1) decreased LF-HRV at T2 and T3 (P < 0.05vs T0 and T1), while nicardipine (8.1 ± 0.8 gmg·kg−1·min−1) showed increase in LF-HRV at T2 (P < 0.05vs T1 ). HF-HRV unchanged through hypotension except for a decrease in group N at T3 (P < 0.05 vs T1). There were no increases in HF-BPV and LF-BPV except for a diltiazem induced decrease in LF-BPV at T3 (P < 0.05vs T0 and T1).
Conclusion
Group D and group DN can be used for deliberate hypotension without an increase in sympathetically mediated LF-HRV
Résumé
Objectif
Observer la variabilité de la fréquence cardiaque (VFC) et de la tension artérielle (VTA) en tant qu’indices des réponses neurocirculatoires à l’hypotension contrôlée avec le diltiazem et/ou la nicardipine lors d’une opération de la hanche.
Méthode
Trente-six patients ASA I–II ont reçu du diltiazem (groupe D, n = 12), de la nicardipine (groupe N, n = 12) ou une combinaison des deux (groupe DN, n = 12). L’intensité de la VFC et de la VTA a été déterminée par une analyse spectrale de VFC et de VTA avant l’anesthésie (T0), juste avant l’induction de l’hypotension (T1) et à 10 et à 30 min après le début de l’hypotension provoquée (T2 et T3, respectivement). Les logarithmes de VFC et VTA ont été intégrés : zone de basses fréquences d’origine sympathique et parasympathique (0,06-0, 1 Hz, BF), zone de hautes fréquences reliée au système parasympathique (0,15-0,4 Hz, HF) et zone incluant toutes les fréquences (0,01-0,4 Hz). La perte sanguine a été évaluée en pesant les compresses et en mesurant le volume aspiré par succion.
Résultats
Dans le groupe DN, la perte sanguine a été moindre (466 ± 46 ml, moyenne ± erreur type) que dans le groupe D (733 ± 100 ml,P < 0,05). Le diltiazem (11,4 ± 0,9μg·kg−1·min−1) et une combinaison de diltiazem (0,25 ± 0,01 mg·kg−1) et de nicardipine (5,9 ± 0,9 μg·kg−1·min−1) ont réduit la VFC-BF à T2 et à T3 (P < 0,05vs T0 et T1 ), tandis que la nicardipine (8,1 ± 0,8 μg·kg−1·min−1) a haussé la VFC-BF à T2 (P < 0,05vs T1 ). La VFC-HF n’a pas changé pendant l’hypotension sauf pour une baisse chez les patients du groupe N à T3 (P < 0,05vs T1 ). Dans le groupe D, il n’y a pas eu d’augmentation de VPS-HF et la VPS-BF a baissé à T3 (P < 0,05).
Conclusion
Les groupes D et DN peuvent servir de modèles dans le cas d’une hypotension contrôlée sans augmentation de la VFC-BF d’origine sympathique.
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Kimura, T., Ito, M., Komatsu, T. et al. Heart rate and blood pressure power spectral analysis during calcium channel blocker induced hypotension. Can J Anesth 46, 1110–1116 (1999). https://doi.org/10.1007/BF03015517
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DOI: https://doi.org/10.1007/BF03015517