Autonomic Reflex Dysfunction in Patients Presenting for Elective Surgery Is Associated with Hypotension after Anesthesia Induction

Latson, Terry W.; Ashmore, T. H.; Reinhart, Douglas J.; Klein, Kevin; Giesecke, A. H.

doi:10.1097/00000542-199402000-00013

Cited by 132 publications

(72 citation statements)

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“…Until now, the predictive value of HRV for cardiovascular events during general anaesthesia has only been investigated in retrospective investigations [19,20,30]. Several years ago, Latson et al [30] demonstrated a greater incidence of hypotension and bradycardia after induction of general anaesthesia in patients with autonomic reflex dysfunction evaluated by a battery of tests and TP > 500 ms 2 .Hz )1 : patients with baseline total power > 500 ms 2 .Hz )1 .…”

Section: Discussionmentioning

confidence: 99%

“…Several years ago, Latson et al [30] demonstrated a greater incidence of hypotension and bradycardia after induction of general anaesthesia in patients with autonomic reflex dysfunction evaluated by a battery of tests and TP > 500 ms 2 .Hz )1 : patients with baseline total power > 500 ms 2 .Hz )1 . BL, baseline; LOW, lowest value after induction of anaesthesia.…”

Section: Discussionmentioning

confidence: 99%

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Does heart rate variability predict hypotension and bradycardia after induction of general anaesthesia in high risk cardiovascular patients?*

et al. 2008

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SummaryThis study investigated whether heart rate variability predicts haemodynamic events in high risk patients, defined as Revised Cardiac Risk Index score = 3, scheduled for general anaesthesia. Fifty patients underwent baseline measurement of heart rate variability and were then assigned according to haemodynamic events (hypotension or bradycardia) after standardised induction of anaesthesia into 'stable' (n = 39) and 'unstable' patients (n = 11). Unstable patients had significantly lower baseline total power. Total power < 500 ms 2 .Hz )1 was associated with high sensitivity and specificity for the prediction of hypotension or bradycardia. Prospectively, 29 patients with total power < 500 ms 2 .Hz )1 were compared with 21 patients with total power > 500 ms 2 .Hz )1 . Differences were found in the lowest mean arterial pressure and heart rate after induction of anaesthesia. We conclude that the pre-operative total power of heart rate variability in high risk patients may indicate the occurrence of haemodynamic events with high sensitivity and specificity. Heart rate variability may be a suitable tool to identify patients at high risk of a haemodynamic event and may be used to indicate need for intensive monitoring and, perhaps, prophylactic treatment. Patients with underlying cardiovascular disease are at high risk of peri-operative cardiovascular events and death [1,2]. Adverse events during anaesthesia and surgery may increase the risk further in this patient population. Specifically, following induction of general anaesthesia, hypotension and bradycardia are often observed and may lead to insufficient organ perfusion and ischaemic events [3][4][5]. Haemodynamic parameters are controlled, to some extent, by the autonomic nervous system. The activity of the autonomic nervous system is reflected in the heart rate variability (HRV) [6][7][8]. Several authors have demonstrated depressed long-term HRV in patients with underlying cardiovascular disease [9][10][11] and HRV has proved to be highly predictive for cardiovascular morbidity and mortality in these patients [12][13][14]. Recently, short-term HRV analysis (5 min) has been shown to be a reliable tool to predict hypotension after spinal anaesthesia [15,16]. The low to high frequency ratio (LF ⁄ HF) was demonstrated to be a highly sensitive parameter to predict hypotension [17] and LF ⁄ HF-guided prophylactic therapy was able to prevent hypotension [18]. Only preliminary data have been published on the incidence of hypotension or bradycardia after induction of general anaesthesia in patients with underlying autonomic dysfunction [19,20]. A retrospective subgroup analysis of a small number of patients with diabetes demonstrated that pre-operative depression of sympathetic and parasympathetic activity was correlated with a significantly greater incidence of hypotension after induction of anaesthesia. However, these results were not confirmed prospectively.This study was designed to investigate the predictive power of HRV in patients with underlying cardiovascu...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Does heart rate variability predict hypotension and bradycardia after induction of general anaesthesia in high risk cardiovascular patients?*

et al. 2008

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“…Patients with severe autonomic dysfunction have a high risk of BP instability, 92,93 and intraoperative BP support is needed more often in those with greater impairment. 15 Intraoperative hypothermia 16 (which may decrease drug metabolism and affect wound healing) and impaired hypoxic induced ventilatory drive 17 have also been shown to be associated with the presence of CAN.…”

Section: Perioperative Managementmentioning

confidence: 99%

Diabetic Cardiovascular Autonomic Neuropathy

2007

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“…Cardiovascular autonomic impairment has been reported to be linked with hypotension during general anesthesia [6][7][8]. In addition, chronic liver disease is associated with cardiovascular autonomic dysfunction, which is characterized by the impairment of sympathetic and parasympathetic reactivity [9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Sympathetic withdrawal is associated with hypotension after hepatic reperfusion

et al. 2013

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Objective Post-reperfusion syndrome (PRS), severe hypotension after graft reperfusion during liver transplantation, is an adverse clinical event associated with poorer patient outcomes. The purpose of this study was to determine whether alterations in autonomic control in liver transplant recipients prior to graft reperfusion are associated with the subsequent development of PRS. Methods Heart rate variability (HRV), systolic arterial blood pressure (SBP) variability, and baroreflex sensitivity of 218 liver transplant recipients were evaluated using 5 min of ECG and arterial blood pressure signals 10 min before graft reperfusion along with other clinical parameters. Logistic regression analyses were performed to assess predictors of PRS occurrence. Results Seventy-seven patients (35 %) developed PRS while 141 did not. There were significant differences in SBP (110 ± 16 vs. 119 ± 16 mmHg, P \ 0.001) and the ratio of low frequency power to high frequency power (LF/ HF) of HRV (1.0 ± 1.4 vs. 2.1 ± 3.7, P = 0.003) between the PRS group and No-PRS group. In multivariate logistic regression analysis, predictors were LF/HF (odds ratio 0.817, P = 0.028) and SBP (odds ratio 0.966, P \ 0.001).Interpretation Low LF/HF and SBP measured before hepatic graft reperfusion were significantly correlated with subsequent PRS occurrence, suggesting that sympathovagal imbalance and depressed SBP may be key factors predisposing to reperfusion-related severe hypotension in liver transplant recipients.

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Autonomic Reflex Dysfunction in Patients Presenting for Elective Surgery Is Associated with Hypotension after Anesthesia Induction

Cited by 132 publications

References 0 publications

Does heart rate variability predict hypotension and bradycardia after induction of general anaesthesia in high risk cardiovascular patients?*

Does heart rate variability predict hypotension and bradycardia after induction of general anaesthesia in high risk cardiovascular patients?*

Diabetic Cardiovascular Autonomic Neuropathy

Sympathetic withdrawal is associated with hypotension after hepatic reperfusion

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