title: Altered autonomic cardiovascular regulation after combined deep and superficial cervical plexus blockade for carotid endarterectomy.
abstract: Compromised cardiac autonomic modulation can produce cardiovascular disturbances. We investigated whether combined deep and superficial cervical plexus (CP) blockade for carotid endarterectomy (CEA) produces changes in autonomic cardiovascular regulation. To estimate alterations in cardiovascular autonomic control before and after combined CP blockade in 22 patients undergoing CEA, the heart rate (HR) variability, systolic blood pressure (SBP) variability, and baroreflex sensitivity were analyzed. We found that SBP (157 +/- 28 mm Hg versus 191 +/- 38 mm Hg before and after combined CP blockade, respectively) and HR (68 +/- 10 bpm versus 84 +/- 9 bpm) increased after combined CP blockade. The high frequency power of HR variability (3.7 +/- 0.9 versus 2.2 +/- 1.2 ln/ms2) decreased (decrease in parasympathetic drive), whereas the low frequency power of SBP variability (5.5 +/- 4.7 versus 8.6 +/- 9.4 mm Hg2) increased (increase in vascular sympathetic outflow). Baroreflex sensitivity decreased, and this decrease was negatively correlated with a SBP increase (r = -0.455). The present results suggest that combined CP blockade impairs autonomic cardiovascular homeostasis and suggests an association between combined CP blockade and intraoperative or postoperative adverse cardiovascular events in high-risk cardiac patients undergoing CEA that merits further studies.
authors.affiliation: Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea.
authors.forename: Young-Kug
authors.initials: YK
authors.lastname: Kim
authors.forename: Gyu-Sam
authors.initials: GS
authors.lastname: Hwang
authors.forename: In-Young
authors.initials: IY
authors.lastname: Huh
authors.forename: Jai-Hyun
authors.initials: JH
authors.lastname: Hwang
authors.forename: Jong-Yeon
authors.initials: JY
authors.lastname: Park
authors.forename: Sung-Lyang
authors.initials: SL
authors.lastname: Chung
authors.forename: Tae-Won
authors.initials: TW
authors.lastname: Kwon
authors.forename: Sung-Min
authors.initials: SM
authors.lastname: Han
mesh_terms: D000368:Aged; D000577:Amides / Q000494:pharmacology; D000779:Anesthetics, Local / Q000494:pharmacology; D001145:Arrhythmias, Cardiac / Q000209:etiology* / Q000473:pathology; D001794:Blood Pressure / Q000187:drug effects; D001993:Bronchodilator Agents / Q000494:pharmacology; D002319:Cardiovascular System / Q000187:drug effects; D002572:Cervical Plexus / Q000473:pathology; D016894:Endarterectomy, Carotid / Q000009:adverse effects* / Q000379:methods*; D004837:Epinephrine / Q000494:pharmacology; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077212:Ropivacaine
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D001993:Bronchodilator Agents; D000077212:Ropivacaine; D004837:Epinephrine