Heart rate variability and the prone position under general versus spinal anesthesia.
OBJECTIVE
To evaluate heart rate (HR) variability in the prone position with power spectral heart rate (PSHR) analysis during spinal and general anesthesia.


METHODS
Prospective, clinical evaluation of HR variability in the prone position.


METHODS
Tertiary care teaching hospital.


METHODS
20 healthy, ASA physical status I and II patients scheduled for elective lumbar spine surgery in the prone position.


METHODS
Anesthetic technique was either a standard general anesthetic or spinal anesthetic, based on the preference of the patient. Power spectral heart rate, HR, and blood pressure (BP) readings were determined prior to anesthetic intervention and as soon as a stable PSHR reading was available in the prone position.


RESULTS
Heart rate and BP were recorded at baseline prior to anesthesia and at the time of stable PSHR data in the prone position. Power spectral heart rate data included low-frequency activity (LFa), high-frequency activity (HFa), and the ratio (LFa/HFa). Spinal anesthesia level was recorded by thoracic dermatome at complete onset. Data were collected from 20 patients; 12 patients chose spinal anesthesia and 8 chose general anesthesia. The prone position resulted in significant increase in HR in the spinal group and significant decrease in BP in the general anesthesia group. Low-frequency activity and LFa/HFa ratio were unchanged in the spinal anesthesia group and were significantly decreased in the general anesthesia group. Spinal level was T8.7.


CONCLUSIONS
The association of less change in LFa activity and preservation of BP on assumption of the prone position in patients during low spinal anesthesia suggests better preservation of autonomic nervous system compensatory mechanisms during low spinal anesthesia than with general anesthesia.
Tetzlaff
J E
JE
Department of General Anesthesiology, Cleveland Clinic Foundation, OH 44195, USA.
O'Hara
J F
JF
Yoon
H J
HJ
Schubert
A
A
D000768:Anesthesia, General; D000775:Anesthesia, Spinal; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D001341:Autonomic Nervous System / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D002045:Bupivacaine / Q000008:administration & dosage; D017558:Elective Surgical Procedures; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D007530:Isoflurane / Q000008:administration & dosage; D007796:Laminectomy; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D009467:Neuromuscular Depolarizing Agents / Q000008:administration & dosage; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage; D009609:Nitrous Oxide / Q000008:administration & dosage; D016684:Prone Position / Q000502:physiology*; D011446:Prospective Studies; D012815:Signal Processing, Computer-Assisted; D013390:Succinylcholine / Q000008:administration & dosage; D013874:Thiopental / Q000008:administration & dosage; D014403:Tubocurarine / Q000008:administration & dosage
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D009467:Neuromuscular Depolarizing Agents; D003473:Neuromuscular Nondepolarizing Agents; D007530:Isoflurane; D013390:Succinylcholine; D013874:Thiopental; D009609:Nitrous Oxide; D014403:Tubocurarine; D002045:Bupivacaine