Changes in heart rate variability in elderly patients undergoing major noncardiac surgery under spinal or general anesthesia.
OBJECTIVE
Heart rate variability (HRV), widely used as an indicator of activity of the autonomic nervous system, has been reported to decrease during and after both spinal and general anesthesia in patients without cardiovascular disease. We evaluated the changes in HRV bands in 40 patients with a high risk of ischemic heart disease.


METHODS
The patients were randomly assigned to receive either spinal (SA) or general anesthesia (GA) for elective total hip arthroplasty or peripheral vascular surgery. Anesthetic techniques and perioperative fluid administration were standardized. Holter monitoring was started preoperatively and continued until the third postoperative day. Three HRV frequency bands were analyzed.


RESULTS
A significant decrease was seen in very low frequency (VLF) and low frequency (LF) bands during GA but not during SA. Also the LF/high frequency (HF) ratio decreased during GA but not during SA. A decrease in all HRV frequency bands was seen after both types of anesthesia. None of the frequency bands returned back to the preoperative level during the 3-day trial. Postoperatively circadian variation was found only in the VLF band after SA.


CONCLUSIONS
The sympathovagal balance (LF/HF) is more stable during SA than during GA in patients with a high risk of ischemic heart disease. The postoperative decrease in HRV bands, however, is independent of the anesthetic technique.
Bäcklund
M
M
Department of Anaesthesia, Helsinki University Central Hospital, Finland.
Toivonen
L
L
Tuominen
M
M
Pere
P
P
Lindgren
L
L
D000368:Aged; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General; D000775:Anesthesia, Spinal; D019644:Arthroplasty, Replacement, Hip; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000503:physiopathology; D011184:Postoperative Period; D012307:Risk Factors; D014656:Vascular Surgical Procedures