TY - JOUR
T1 - Heart rate variability predicts severe hypotension after spinal anesthesia for elective cesarean delivery
AU - Hanss, R.
AU - Bein, B.
AU - Ledowski, Thomas
AU - Lehmkuhl, M.
AU - Ohnesorge, H.
AU - Scherkl, W.
AU - Steinfath, M.
AU - Scholz, J.
AU - Tonner, P.h.
PY - 2005
Y1 - 2005
N2 - Background: Hypotension due to vasodilation during subarachnoid block (SAB) for elective cesarean delivery may be harmful. Heart rate variability (HRV), reflecting autonomic control, may identify patients at risk of hypotension. Methods: Retrospectively, HRV was analyzed in 41 patients who were classified into one of three groups depending on the decrease in systolic blood pressure (SBP): mild (SBP > 100 mmHg), moderate (100 > SBP > 80 mmHg), or severe (SBP <80 mmHg). Prospectively, HRV and hemodynamic data of 19 patients were studied. Relative low frequency (LF), relative high frequency (HF), and LF/HF ratio were analyzed. Results: Retrospective analysis of HRV showed a significantly higher sympathetic and lower parasympathetic drive in the groups with moderate and severe compared with mild hypotension before SAB (median, 25th/75th percentiles): LF/HF: mild: 1.2 (0.9/1.8), moderate: 2.8 (1.8/4.6), P <0.05 versus mild; severe: 2.7 (2.0/3.5), P <0.05 versus mild. Results were confirmed by findings of LF and HF. Prospectively, patients were grouped according to LF/HF before SAB: low-LF/HF: 1.5 (1.1/2.0) versus high-LF/HF: 4.0 (2.8/4.7), P <0.05; low-LF: 58 ± 9% versus high-LF: 75 ± 10%, P <0.05; low-HF: 41 ± 10% versus high-HF: 25 ± 10%, P <0.05. High-risk patients had a significantly lower SBP after SAB (76 ± 21 vs. 111 ± 12 mmHg; P <0.05). Conclusions: Retrospectively analyzed HRV of patients scheduled to undergo elective cesarean delivery during SAB showed significant differences depending on the severity of hypotension after SAB. Preliminary findings were prospectively confirmed. High LF/HF before SAB predicted severe hypotension. Preoperative HRV analysis may detect patients at risk of hypotension after SAB.
AB - Background: Hypotension due to vasodilation during subarachnoid block (SAB) for elective cesarean delivery may be harmful. Heart rate variability (HRV), reflecting autonomic control, may identify patients at risk of hypotension. Methods: Retrospectively, HRV was analyzed in 41 patients who were classified into one of three groups depending on the decrease in systolic blood pressure (SBP): mild (SBP > 100 mmHg), moderate (100 > SBP > 80 mmHg), or severe (SBP <80 mmHg). Prospectively, HRV and hemodynamic data of 19 patients were studied. Relative low frequency (LF), relative high frequency (HF), and LF/HF ratio were analyzed. Results: Retrospective analysis of HRV showed a significantly higher sympathetic and lower parasympathetic drive in the groups with moderate and severe compared with mild hypotension before SAB (median, 25th/75th percentiles): LF/HF: mild: 1.2 (0.9/1.8), moderate: 2.8 (1.8/4.6), P <0.05 versus mild; severe: 2.7 (2.0/3.5), P <0.05 versus mild. Results were confirmed by findings of LF and HF. Prospectively, patients were grouped according to LF/HF before SAB: low-LF/HF: 1.5 (1.1/2.0) versus high-LF/HF: 4.0 (2.8/4.7), P <0.05; low-LF: 58 ± 9% versus high-LF: 75 ± 10%, P <0.05; low-HF: 41 ± 10% versus high-HF: 25 ± 10%, P <0.05. High-risk patients had a significantly lower SBP after SAB (76 ± 21 vs. 111 ± 12 mmHg; P <0.05). Conclusions: Retrospectively analyzed HRV of patients scheduled to undergo elective cesarean delivery during SAB showed significant differences depending on the severity of hypotension after SAB. Preliminary findings were prospectively confirmed. High LF/HF before SAB predicted severe hypotension. Preoperative HRV analysis may detect patients at risk of hypotension after SAB.
U2 - 10.1097/00000542-200506000-00005
DO - 10.1097/00000542-200506000-00005
M3 - Article
VL - 102
SP - 1086
EP - 1093
JO - Anethesiology
JF - Anethesiology
SN - 0003-3022
IS - 6
ER -