title: Effects of pneumoperitoneum on cardiac autonomic nervous activity evaluated by heart rate variability analysis during sevoflurane, isoflurane, or propofol anesthesia.
abstract: BACKGROUND
  The effects of pneumoperitoneum on the activity of the cardiac autonomic nervous system have not been completely understood.
  
  
  METHODS
  In this study, 45 unpremedicated adult patients who underwent laparoscopic cholecystectomy were anesthetized with either 3.5% sevoflurane, 2% isoflurane, or 8 mg/kg/h propofol (15 patients in each group). The status of cardiac autonomic nervous activity was evaluated by heart rate variability analysis three times: once when the patient was awake, once after induction of general anesthesia, and once after insufflation for pneumoperitoneum. Intra-abdominal pressure was maintained automatically at 10 mm Hg by a carbon dioxide (CO(2)) insufflator. For each measurement, electrocardiogram was recorded for 256 s and played back offline to detect R-R intervals. Power spectral analysis of heart rate variability was applied, and the low-frequency (LF, 0.04-0.15 Hz) and high-frequency (HF, 0.15-0. 40 Hz) bands of the spectral density of the heart rate variability were obtained from a power spectra of R-R intervals using the fast-Fourier transform algorithm. The HF/LF ratio also was analyzed.
  
  
  RESULTS
  Measurements of heart rate variability in the three groups showed similar change. Although the power of HF, which represents parasympathetic nervous activity, did not change, the power of LF, which represents both sympathetic and parasympathetic nervous activity, decreased during the anesthetized stage and increased during the insufflated stage. The HF/LF ratio, which represents the balance of parasympathetic and sympathetic activity, increased after induction of general anesthesia, and decreased after insufflation.
  
  
  CONCLUSIONS
  Our results suggest that pneumoperitoneum increases sympathetic cardiac activity. The choice of general anesthetic did not seem to have a major influence on the change in the cardiac autonomic nervous system after induction of pneumoperitoneum for laparoscopic cholecystectomy.
authors.affiliation: Department of Anesthesia, Hiroshima General Hospital, Hatsukaichi-Jigozen 1-3-3, Hiroshima 738, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Sato
authors.forename: M
authors.initials: M
authors.lastname: Kawamoto
authors.forename: O
authors.initials: O
authors.lastname: Yuge
authors.forename: H
authors.initials: H
authors.lastname: Suyama
authors.forename: M
authors.initials: M
authors.lastname: Sanuki
authors.forename: C
authors.initials: C
authors.lastname: Matsumoto
authors.forename: K
authors.initials: K
authors.lastname: Inoue
mesh_terms: D000328:Adult; D000758:Anesthesia / Q000379:methods*; D018685:Anesthetics, Inhalation / Q000008:administration & dosage*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D001341:Autonomic Nervous System / Q000187:drug effects / Q000502:physiology*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods; D004562:Electrocardiography; D005260:Female; D005583:Fourier Analysis; D006321:Heart / Q000294:innervation*; D006339:Heart Rate / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D007530:Isoflurane / Q000008:administration & dosage; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011028:Pneumoperitoneum, Artificial; D015742:Propofol / Q000008:administration & dosage; D000077149:Sevoflurane
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D000077149:Sevoflurane; D007530:Isoflurane; D015742:Propofol