Heart rate variability predicts severe hypotension after spinal anesthesia.
BACKGROUND
Hypotension due to vasodilatation after spinal anesthesia (SA) may be harmful. Heart rate variability, an indirect measure of autonomic control, may predict hypotension.


METHODS
One hundred patients were studied. Retrospectively, heart rate variability was analyzed in 30 patients, classified depending on the lowest systolic blood pressure (SBP) after SA. Seventy patients were studied prospectively, assigned to one of two groups by their low to high frequency ratio (LF/HF) before SA. Sensitivity and specificity of LF/HF for prediction of decrease of SBP greater 20% of baseline were tested.


RESULTS
Retrospective analysis showed differences of LF/HF depending on the degree of hypotension after SA. Prospective analysis demonstrated significant differences of SBP after SA depending on baseline LF/HF (mean +/- SD): low LF/HF (1.3 +/- 0.7) = > SBP: 91 +/- 8% of baseline versus high LF/HF (5.5 +/- 2.4) = > SBP: 66 +/- 10% of baseline (P < 0.05). Baseline LF/HF as well as high frequency and proportional decrease of SBP after SA correlated significantly, in contrast to baseline hemodynamic parameters heart rate and SBP. A receiver operator curve characteristic analysis showed a sensitivity and specificity of LF/HF > 2.5 of 85% to predict SBP decrease of greater than 20% of baseline after SA.


CONCLUSIONS
Heart rate variability analysis before SA may predict hypotension after SA with high sensitivity and specificity. LF/HF may be a tool to detect patients at high risk of hypotension due to SA. This indicates that the predictive value of LF/HF is superior to established predictors.
Hanss
Robert
R
Department of Anesthesiology and Intensive Care Medicine, University-Hospital Schleswig-Holstein, Campus Kiel, Germany. hanss@anaesthesie.uni-kiel.de
Bein
Berthold
B
Weseloh
Hendrik
H
Bauer
Martin
M
Cavus
Erol
E
Steinfath
Markus
M
Scholz
Jens
J
Tonner
Peter H
PH
D000368:Aged; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D006339:Heart Rate; D006801:Humans; D007022:Hypotension / Q000209:etiology*; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D013599:Systole