Korean J Anesthesiol.  2013 Oct;65(4):317-321. 10.4097/kjae.2013.65.4.317.

Heart rate variability as a predictor of hypotension after spinal anesthesia in hypertensive patients

• Kweon TD
• Kim SY
• Cho SA
• Kim JH
• Kang YR
• Shin YS

• KMID: 2164867
• DOI: http://doi.org/10.4097/kjae.2013.65.4.317

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.

Keyword

Hypertension; Hypotension; Parasympathetic nervous system; Spinal anesthesia; Sympathetic nervous system

MeSH Terms

Anesthesia, Spinal*
Area Under Curve
Arterial Pressure
Heart Rate*
Heart*
Humans
Hypertension
Hypotension*
Isotonic Solutions
Parasympathetic Nervous System
ROC Curve
Sympathetic Nervous System
Isotonic Solutions