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CARDIOVASCULAR ANESTHESIA

Altered Autonomic Cardiovascular Regulation After Combined Deep and Superficial Cervical Plexus Blockade for Carotid Endarterectomy

Young-Kug Kim, MD^*, Gyu-Sam Hwang, MD^*, In-Young Huh, MD^*, Jai-Hyun Hwang, MD^*, Jong-Yeon Park, MD^*, Sung-Lyang Chung, MD^*, Tae-Won Kwon, MD, and Sung-Min Han, MD^*

From the *Department of Anesthesiology and Pain Medicine and Division of Vascular Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

Address correspondence and reprint requests to Gyu-Sam Hwang, MD, Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap-2dong, Songpa-gu, Seoul, 138-736, Korea. Address e-mail to kshwang{at}amc.seoul.kr.

Compromised cardiac autonomic modulation can produce cardiovascular disturbances. We investigated whether combined deep and superficial cervical plexus (CP) blockade for carotid endarterectomy (CEA) produces changes in autonomic cardiovascular regulation. To estimate alterations in cardiovascular autonomic control before and after combined CP blockade in 22 patients undergoing CEA, the heart rate (HR) variability, systolic blood pressure (SBP) variability, and baroreflex sensitivity were analyzed. We found that SBP (157 ± 28 mm Hg versus 191 ± 38 mm Hg before and after combined CP blockade, respectively) and HR (68 ± 10 bpm versus 84 ± 9 bpm) increased after combined CP blockade. The high frequency power of HR variability (3.7 ± 0.9 versus 2.2 ± 1.2 ln/ms²) decreased (decrease in parasympathetic drive), whereas the low frequency power of SBP variability (5.5 ± 4.7 versus 8.6 ± 9.4 mm Hg²) increased (increase in vascular sympathetic outflow). Baroreflex sensitivity decreased, and this decrease was negatively correlated with a SBP increase (r = –0.455). The present results suggest that combined CP blockade impairs autonomic cardiovascular homeostasis and suggests an association between combined CP blockade and intraoperative or postoperative adverse cardiovascular events in high-risk cardiac patients undergoing CEA that merits further studies.