J Clin Monit Comput - Baroreflex sensitivity variations in response to propofol anesthesia: comparison between normotensive and hypertensive patients.

Tópicos

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Resumo

The aim of this paper is to compare baroreflex sensitivity (BRS) following anesthesia induction via propofol to pre-induction baseline values through a systematic and mathematically robust analysis. Several mathematical methods for BRS quantification were applied to pre-operative and intra-operative data collected from patients undergoing major surgery, in order to track the trend in BRS variations following anesthesia induction, as well as following the onset of mechanical ventilation. Finally, a comparison of BRS trends in chronic hypertensive patients (CH) with respect to non hypertensive (NH) patients was performed. 10 NH and 7 CH patients undergoing major surgery with American Society of Anesthesiologists classification score 2.5???0.5 and 2.6???0.5 respectively, were enrolled in the study. A Granger causality test was carried out to verify the causal relationship between RR interval duration and systolic blood pressure (SBP), and four different mathematical methods were used to estimate the BRS: (1) ratio between autospectra of RR and SBP, (2) transfer function, (3) sequence method and (4) bivariate closed loop model. Three different surgical epochs were considered: baseline, anesthetic procedure and post-intubation. In NH patients, propofol administration caused a decrease in arterial blood pressure (ABP), due to its vasodilatory effects, and a reduction of BRS, while heart rate (HR) remained unaltered with respect to baseline values before induction. A larger decrease in ABP was observed in CH patients when compared to NH patients, whereas HR remained unaltered and BRS was found to be lower than in the NH group at baseline, with no significant changes in the following epochs when compared to baseline. To our knowledge, this is the first study in which the autonomic response to propofol induction in CH and NH patients was compared. The analysis of BRS through a mathematically rigorous procedure in the perioperative period could result in the availability of additional information to guide therapy and anesthesia in uncontrolled hypertensive patients, which are prone to a higher rate of hypotension events occurring during general anesthesia induction.

Resumo Limpo

aim paper compar baroreflex sensit brs follow anesthesia induct via propofol preinduct baselin valu systemat mathemat robust analysi sever mathemat method brs quantif appli preoper intraop data collect patient undergo major surgeri order track trend brs variat follow anesthesia induct well follow onset mechan ventil final comparison brs trend chronic hypertens patient ch respect non hypertens nh patient perform nh ch patient undergo major surgeri american societi anesthesiologist classif score respect enrol studi granger causal test carri verifi causal relationship rr interv durat systol blood pressur sbp four differ mathemat method use estim brs ratio autospectra rr sbp transfer function sequenc method bivari close loop model three differ surgic epoch consid baselin anesthet procedur postintub nh patient propofol administr caus decreas arteri blood pressur abp due vasodilatori effect reduct brs heart rate hr remain unalt respect baselin valu induct larger decreas abp observ ch patient compar nh patient wherea hr remain unalt brs found lower nh group baselin signific chang follow epoch compar baselin knowledg first studi autonom respons propofol induct ch nh patient compar analysi brs mathemat rigor procedur periop period result avail addit inform guid therapi anesthesia uncontrol hypertens patient prone higher rate hypotens event occur general anesthesia induct

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