Anesth Analg 2006;103:264
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000215217.79856.AB
LETTER TO THE EDITOR
Heart Rate Variability as a Promising Tool to Predict Hypotension
Robert Hanss, MD,
Peter H. Tonner, MD,
Jens Scholz, MD, and
Berthold Bein, MD
Department of Anesthesiology and Intensive Care Medicine; University Hospital Schleswig-Holstein, Campus Kiel; Kiel, Germany; hanss{at}anaesthesie.uni-kiel.de
To the Editor:
Reich et al. (1) recently published predictors of hypotension after induction of general anesthesia. Postinduction hypotension was significantly correlated with ASA status, baseline hypotension, and use of propofol as the induction hypnotic. In our view, these clinical variables may be reasonably completed by noninvasive analysis of heart rate variability (HRV) as a surrogate for the drive of the autonomous nervous system. Chamchad et al. (2) found a significant correlation of nonlinear HRV dimension analysis with the incidence of hypotension occurring after spinal anesthesia for cesarean delivery. More recently we demonstrated that HRV-derived variables were able to predict hypotension after spinal anesthesia in pregnant women (3) and elderly men (4). For this purpose, our group has investigated the ratio of low to high frequency peaks of the power spectrum (LF/HF) reflecting the balance of sympathetic and parasympathetic activity. A significant correlation between postspinal hypotension and a specific threshold LF/HF ratio was shown. These results have not been confirmed in patients undergoing general anesthesia. Nevertheless, HRV analysis may help predict the risk of hypotension in this patient population.
REFERENCES
- Reich DL, Hossain S, Krol M, et al. Predictors of hypotension after induction of general anesthesia. Anesth Analg 2005;101:622–8.[Abstract/Free Full Text]
- Chamchad D, Arkoosh VA, Horrow JC, et al. Using heart rate variability to stratify risk of obstetric patients undergoing spinal anesthesia. Anesth Analg 2004;99: 1818–21.[Abstract/Free Full Text]
- Hanss R, Bein B, Ledowski T, et al. Heart rate variability predicts severe hypotension after spinal anesthesia for elective cesarean delivery. Anesthesiology 2005; 102:1086–93.[Web of Science][Medline]
- Hanss R, Bein B, Francksen H, et al. Heart rate variability-guided prophylactic treatment of severe hypotension after subarachnoid block for elective cesarean delivery. Anesthesiology 2006;104:635–43.[Medline]
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