Changes in autonomic nervous activity during endoscopic retrograde cholangiopancreatography: a possible factor in cardiac complications.
OBJECTIVE
The changes of autonomic nervous activity during endoscopic retrograde cholangiopancreatography (ERCP) are closely related to the development of cardiovascular complications, such as arrhythmias and acute coronary syndrome. In the present study, the correlation between changes in hemodynamics and autonomic nervous activity during ERCP procedures was evaluated by analyzing heart rate variability and blood catecholamine levels.


METHODS
Twenty-three patients who underwent ERCP (ERCP group) and 15 control subjects who were only premedicated (C group) were studied. Ambulant ECG, blood pressure, arterial oxygen saturation, and blood level of catecholamine were measured. Autonomic nervous function was assessed by analyzing the spectral analysis and 1/f fluctuation. The low frequency power (LF power; 0.04-0.15 Hz), high frequency power (HF power; 0.15-0.40 Hz, indicator of parasymapathetic tone), the ratio of LF power to HF power (LF/HF ratio, indicator of sympathetic tone), and 1/f fluctuation (indicator of pleasant mood) were calculated.


RESULTS
Blood pressure and heart rate were increased and arterial oxygen saturation was decreased in the ERCP group during the endoscopic procedure. Changes in the parameters of autonomic nervous function (LF power, HF power, LF/HF ratio, and 1/f fluctuation) were significantly greater in the ERCP group than in the C group, especially during cholangiography. Moreover, blood levels of catecholamines were significantly increased during the ERCP procedure. In the C group, however, blood levels of catecholamines did not significantly change except directly after premedication.


CONCLUSIONS
Autonomic nervous activity varied greatly during cholangiography, demonstrating that ERCP has more than a little influence on the cardiovascular system. The results of the present study indicated that attention should be focused on changes in hemodynamics in patients with cardiovascular complications by monitoring the aforementioned hemodynamic parameters during ERCP.
Ochi
Yoshie
Y
Second Department of Internal Medicine, University of Tokushima, Japan.
Nomura
Masahiro
M
Okamura
Seisuke
S
Yano
Mitsuyasu
M
Saito
Ken
K
Nakaya
Yutaka
Y
Ito
Susumu
S
D000328:Adult; D000368:Aged; D001341:Autonomic Nervous System / Q000503:physiopathology*; D001785:Blood Gas Monitoring, Transcutaneous; D001794:Blood Pressure / Q000502:physiology; D001795:Blood Pressure Determination; D002395:Catecholamines / Q000097:blood; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D015716:Electrocardiography, Ambulatory; D005260:Female; D006331:Heart Diseases / Q000209:etiology* / Q000503:physiopathology*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
D002395:Catecholamines