Comparison of heart rate variability response in children undergoing elective endotracheal intubation with and without neuromuscular blockade: a randomized controlled trial

Janda, Matthias; Bajorat, J.; Kudlik, Christiana; Pohl, B.; Schubert, A.; Nöldge-Schomburg, Gabriele; Hofmockel, R.

doi:10.1111/pan.12236

Cited by 10 publications

(8 citation statements)

References 28 publications

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“…Patients in previous studies [10–13] did not receive neuromuscular blocking drugs before stimulation, whereas we used a regime with rocuronium. The previously described variation in autonomous stress response to tracheal intubation with and without neuromuscular blockade may partially explain the observed differences [23].…”

Section: Discussionmentioning

confidence: 95%

Newborn infant parasympathetic evaluation (NIPE) as a predictor of hemodynamic response in children younger than 2 years under general anesthesia: an observational pilot study

Zhang

Wang

et al. 2019

BMC Anesthesiol

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Background It is still unknown whether newborn infant parasympathetic evaluation (NIPE), based on heart rate variability (HRV) as a reflection of parasympathetic nerve tone, can predict the hemodynamic response to a nociception stimulus in children less than 2 years old. Methods Fifty-five children undergoing elective surgery were analyzed in this prospective observational study. Noninvasive mean blood pressure (MBP), heart rate (HR) and NIPE values were recorded just before and 1 min after general anesthesia with endotracheal intubation as well as skin incision. The predictive performance of NIPE was evaluated by receiver-operating characteristic (ROC) curve analysis. A significant hemodynamic response was defined by a > 20% increase in HR and/or MBP. Results Endotracheal intubation and skin incision caused HR increases of 22.2% (95% confidence interval [CI] 17.5–26.9%) and 3.8% (2.1–5.5%), MBP increases of 18.2% (12.0–24.4%) and 10.6% (7.7–13.4%), and conversely, NIPE decreases of 9.9% (5.3–14.4%) and 5.6% (2.1–9.1%), respectively (all P < 0.01 vs. pre-event value). Positive hemodynamic responses were observed in 32 patients (62.7%) during tracheal intubation and 13 patients (23.6%) during skin incision. The area under the ROC curve values for the ability of NIPE to predict positive hemodynamic responses at endotracheal intubation and skin incision were 0.65 (0.50–0.78) and 0.58 (0.44–0.71), respectively. Conclusions NIPE reflected nociceptive events as well as anesthestic induction in children less than 2 years undergoing general anaesthetia. Nevertheless, NIPE may not serve as a sensitive and specific predictor to changes in hemodynamics. Trial registration This study was registered on May 3, 2018 in the Chinese Clinical Trail Registry; the registration number is ( ChiCTR1800015973 ).

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Section: Discussionmentioning

confidence: 95%

Newborn infant parasympathetic evaluation (NIPE) as a predictor of hemodynamic response in children younger than 2 years under general anesthesia: an observational pilot study

Zhang

Wang

et al. 2019

BMC Anesthesiol

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“… 2 Janda et al detected heart rate variability (HRV) in children who received endotracheal intubation, demonstrating that children without muscle relaxant had higher HRV parameters such as low frequency/high frequency ratio after intubation, and they had stronger stress response to endotracheal intubation than those with muscle relaxant. 26 Relaxation of skeletal muscle is conducive to reducing the confrontation between the skeletal muscle of the affected limb and the great pressure of the tourniquet, thus alleviating the postoperative swelling, pain, and discomfort of the affected limb’s tourniquet compression area, relieving the stress response caused by the tourniquet and surgical operation, and reducing the IRI to skeletal muscle induced by the tourniquet. 19 …”

Section: Discussionmentioning

confidence: 99%

<p>Protective Effects of Rocuronium Bromide on Ischemia-Reperfusion Injury in Skeletal Muscle Induced by Tourniquet in Patients Undergoing Elective Unilateral Total Knee Arthroplasty: A Prospective, Double Blind, Randomized, Controlled Study</p>

Chen

Wei

Wang

et al. 2020

DDDT

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To investigate the effects of different doses of rocuronium on ischemiareperfusion injury in skeletal muscle induced by tourniquet in patients undergoing elective unilateral total knee arthroplasty. Patients and Methods: A total of 90 patients undergoing elective unilateral knee arthroplasty under general anesthesia combined with femoral nerve block were randomly divided into 3 groups: normal saline group (group S), rocuronium 0.6 mg/kg group (group L), and rocuronium 1.2 mg/kg group (group H). The primary outcome was the expression of dystrophin in skeletal muscle at 60 min after ischemia. Secondary outcomes included the concentration of malondialdehyde (MDA) and neuronal nitric oxide synthase (nNOS) in blood at 5 min and 30 min after reperfusion. In addition, thigh girth at 24 h and 48 h after operation, the leaving bed time, the incidence of tourniquet-related hypertension and short-term (3 days after operation) complications (nausea and vomiting, swelling, blister, wound infection) and long-term (3 months after operation) complications (joint instability, stiffness, nerve paralysis, pain) were recorded. Main Results: The expression of dystrophin in the rocuronium group was higher than that in group S after ischemia (P <0.05). The concentration of MDA in the rocuronium 1.2 mg/kg group was lower at 30 min after reperfusion (P < 0.05). There was no significant difference in nNOS among groups at each time point (P > 0.05). The change of thigh girth was the smallest in the rocuronium 1.2 mg/kg group after operation (P<0.05). The leaving bed time was significantly earlier after operation in the rocuronium group than that in group S (P <0.05). Conclusion: Rocuronium can protect skeletal muscle from ischemia-reperfusion injury induced by tourniquet. The mechanism may be related to the fact that rocuronium can reduce the loss of dystrophin in skeletal muscle and have the effects of anti-oxidation and anti-stress. Trial Registration: The study was registered at http://www.chictr.org.cn (ChiCTR1800019221, registered on 2018-10-31).

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“…As seen in Table 1, MAP and HR were not affected by NMB at baseline [22]. A possible explanation for the increase in MAP with abdominal CO 2 insufflation in group B could be Working space distance (cm) IAP (mmHg) the interference of NMB with the reactions of the autonomic nervous system [23,24].…”

Section: Discussionmentioning

confidence: 99%

Optimizing working space in laparoscopy: CT-measurement of the effect of neuromuscular blockade and its reversal in a porcine model

et al. 2014

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Comparison of heart rate variability response in children undergoing elective endotracheal intubation with and without neuromuscular blockade: a randomized controlled trial

Cited by 10 publications

References 28 publications

Newborn infant parasympathetic evaluation (NIPE) as a predictor of hemodynamic response in children younger than 2 years under general anesthesia: an observational pilot study

Newborn infant parasympathetic evaluation (NIPE) as a predictor of hemodynamic response in children younger than 2 years under general anesthesia: an observational pilot study

<p>Protective Effects of Rocuronium Bromide on Ischemia-Reperfusion Injury in Skeletal Muscle Induced by Tourniquet in Patients Undergoing Elective Unilateral Total Knee Arthroplasty: A Prospective, Double Blind, Randomized, Controlled Study</p>

Optimizing working space in laparoscopy: CT-measurement of the effect of neuromuscular blockade and its reversal in a porcine model

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