Heart rate variability may be more useful than pulse transit time for confirming successful caudal block under general anesthesia in children.
10.17085/apm.2017.12.2.140
- Author:
In Kyung SONG
1
;
Sanghwan JI
;
Eun Hee KIM
;
Ji Hyun LEE
;
Jin Tae KIM
;
Hee Soo KIM
Author Information
1. Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea. dami0605@snu.ac.kr
- Publication Type:Original Article
- Keywords:
Caudal anesthesia;
Heart rate
- MeSH:
Anesthesia;
Anesthesia, Caudal;
Anesthesia, General*;
Auscultation;
Child*;
Electrocardiography;
Entropy;
Epinephrine;
Heart Rate*;
Heart*;
Humans;
Male;
Peripheral Nerves;
Pulse Wave Analysis*;
Ultrasonography
- From:Anesthesia and Pain Medicine
2017;12(2):140-146
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: Confirming a successful caudal block is challenging in the pediatric population. Pulse transit time (PTT) may reflect the decrease in arterial resistance and may act as a potential indicator for confirming successful peripheral nerve or axial block. Heart rate variability (HRV) is also a possible candidate because it may be influenced by variation in sympathetic tone. We expected an increasing PTT pattern and change in HRV parameters after caudal block. METHODS: We enrolled 27 male patients (range, 1–4 years old) who were scheduled for urological surgeries. Caudal block was performed with 1 ml/kg of 0.25% ropivacaine and 1 : 200,000 epinephrine under sevoflurane anesthesia after the surgery. Successful block was confirmed by auscultation and ultrasonography. PTT and HRV parameters, such as standard deviation of normal-to-normal intervals, root mean square of successive differences, very low-frequency power, low-frequency power (LF), high-frequency power (HF), LF/HF ratio, approximate entropy (ApEn) were calculated based on electrocardiography from 1 min before to 5 min after the block. Those variables were analyzed by repeated measures analysis of variance. RESULTS: No significant change was found in PTT with time interval after caudal block. Heart rate and ApEn of the R-R interval decreased with time interval (P = 0.001, 0.033, respectively). Some HRV parameters showed notable changes, although statistically insignificant. CONCLUSIONS: The PTT pattern may not be an indicator for successful caudal block. However, heart rate with parameters of HRV analysis may be alternatives.
