Heart rate variability during total intravenous anesthesia: effects of nociception and analgesia.
BACKGROUND
Changes in heart rate variability (HRV) during anesthesia likely result from the interaction of hypnosis, surgical stimulation, analgesia and direct cardiovascular effects of drugs, but the interaction between these variables is unclear. This study was designed to characterize the impact of both surgical nociception and analgesia on HRV in propofol-anesthetized patients.


METHODS
HRV was analyzed using wavelet transform in 49 patients (ASA status 1-2) before induction of anesthesia and then throughout stable anesthesia with propofol, in the absence of nociceptive stimulation, and then during surgery, in the presence of deep (adequate) or light (inadequate) analgesia provided by various opioids (sufentanil [n=19], alfentanil [n=18], or remifentanil [n=12].


RESULTS
Anesthesia reduced total power as well as high frequency (HF) and low frequency (LF) powers (all: P<0.01), with an increase (P=0.002) in the proportional part of HF power (HFnu). During nociception, HFnu decreased in a sensitive and reproducible way (P<0.01) in case of light analgesia, whereas HRV did not change when patient received adequate analgesia.


CONCLUSIONS
The nociception-analgesia balance is a direct determinant of HRV during surgical anesthesia. HFnu may behave like an early indicator of inadequate analgesia. These results have potential implication for monitoring adequacy of analgesia in healthy patients undergoing intravenous anesthesia. Additional work is needed for application across patient populations.
Jeanne
Mathieu
M
Pôle d'Anesthésie Réanimation, hôpital Roger Salengro, CHU de Lille, France.
Logier
Régis
R
De Jonckheere
Julien
J
Tavernier
Benoît
B
D000328:Adult; D000344:Afferent Pathways / Q000187:drug effects / Q000503:physiopathology; D000777:Anesthetics / Q000009:adverse effects*; D018686:Anesthetics, Intravenous / Q000009:adverse effects; D001145:Arrhythmias, Cardiac / Q000139:chemically induced* / Q000503:physiopathology*; D003243:Consciousness / Q000187:drug effects / Q000502:physiology; D005260:Female; D006321:Heart / Q000187:drug effects / Q000294:innervation / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D006991:Hypnosis, Anesthetic / Q000009:adverse effects; D007431:Intraoperative Complications / Q000209:etiology / Q000503:physiopathology; D008297:Male; D009619:Nociceptors / Q000187:drug effects / Q000502:physiology; D010146:Pain / Q000150:complications* / Q000503:physiopathology; D015742:Propofol / Q000009:adverse effects; D013564:Sympathetic Nervous System / Q000187:drug effects / Q000503:physiopathology; D055815:Young Adult
D000777:Anesthetics; D018686:Anesthetics, Intravenous; D015742:Propofol