Heart rate variability as a predictor of hypotension after spinal anesthesia in hypertensive patients.
10.4097/kjae.2013.65.4.317
- Author:
Tae Dong KWEON
1
;
So Yeon KIM
;
Sung Ah CHO
;
Ji Hoon KIM
;
Young Ran KANG
;
Yang Sik SHIN
Author Information
1. Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea. ysshin@yuhs.ac
- Publication Type:Original Article
- Keywords:
Hypertension;
Hypotension;
Parasympathetic nervous system;
Spinal anesthesia;
Sympathetic nervous system
- MeSH:
Anesthesia, Spinal*;
Area Under Curve;
Arterial Pressure;
Heart Rate*;
Heart*;
Humans;
Hypertension;
Hypotension*;
Isotonic Solutions;
Parasympathetic Nervous System;
ROC Curve;
Sympathetic Nervous System
- From:Korean Journal of Anesthesiology
2013;65(4):317-321
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: Hypotension is a common phenomenon after spinal anesthesia in hypertensive patients. We investigated whether heart rate variability could predict the occurrence of hypotension after spinal anesthesia in hypertensive patients. METHODS: Forty-one patients undergoing spinal anesthesia were included. Heart rate variability was measured at five different time points such as before fluid loading (baseline), after fluid loading as well as 5 min, 15 min and 30 min after spinal anesthesia. Fluid loading was performed using 5 ml/kg of a crystalloid solution. Baseline total power and low to high frequency ratio (LF/HF) in predicting hypotension after spinal anesthesia were analyzed by calculating the area under the receiver operating characteristic curves (AUC). RESULTS: Moderate hypotension, defined as a decrease of mean arterial pressure to below 20-30% of the baseline, occurred in 13 patients and severe hypotension, defined as a decrease of mean arterial pressure greater than 30% below the baseline, occurred in 7 patients. LF/HF ratiosand total powers did not significantly change after spinal anesthesia. AUCs of LF/HF ratio for predicting moderate hypotension was 0.685 (P = 0.074), severe hypotension was 0.579 (P = 0.560) and moderate or severe hypotension was 0.652 (P = 0.101), respectively. AUCs of total power for predicting moderate hypotension was 0.571 (P = 0.490), severe hypotension was 0.672 (P = 0.351) and moderate or severe hypotension was 0.509 (P = 0.924), respectively. CONCLUSIONS: Heart rate variability is not a reliable predictor of hypotension after spinal block in hypertensive patients whose sympathetic activity is already depressed.
