CJA
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
This Article
Right arrow Full Text (PDF)
Right arrow Submit a scholarly reply
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Kohno, N.
Right arrow Articles by Taneyama, C.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Kohno, N.
Right arrow Articles by Taneyama, C.

Canadian Journal of Anesthesia, Vol 45, 746-752, Copyright © 1998 by Canadian Anesthesiologists' Society

ARTICLES

Surgical stress attenuates reflex heart rate response to hypotension

N Kohno and C Taneyama
Department of Anesthesiology, Suwa Red Cross Hospital, Japan.

PURPOSE: The baroreflex-mediated increase in heart rate (HR) in response to acute reduction of systolic blood pressure (SBP) was studied in order to assess whether the changes in arterial baroreflex sensitivity depend on the intensity of surgical stress, and location of visceral and somatic stimulation during surgery. METHODS: Patients were divided into visceral stimulation groups [upper (n = 30) and lower (n = 30) abdominal surgery] and somatic stimulation groups [upper (n = 25) and lower (n = 25) limbs, and chest wall (n = 25) surgery]. Acute hypotension as a baroreflex depressor test was induced by prostaglandin E1 (PGE1) 10 min before surgical incision (control) and during surgical manipulation under isoflurane-N2O anaesthesia or isoflurane-N2O-fentanyl anaesthesia. Plasma level of ACTH was measured in an additional 40 patients who underwent upper abdominal surgery. RESULTS: During upper abdominal surgery, the heart rate baroreflex sensitivity (delta HR/delta SBP) was depressed from -0.47 +/- 0.05 (control) to -0.01 +/- 0.04 (P < 0.05). The reflex heart rate baroreflex sensitivity remained unchanged and was similar among the remaining groups of patients. The concentration of ACTH increased from 12.5 +/- 1.0 (control) to 343 +/- 78.6 pg.ml-1 (P < 0.05) with isoflurane-N2O anaesthesia but did not change with isoflurane-N2O-fentanyl anaesthesia during upper abdominal surgery. CONCLUSION: Upper abdominal surgery is associated with the most stressful stimulation to attenuate heart rate baroreflex sensitivity. Integrity of the baroreflex can be preserved by adding opioids to supplement inhalation anaesthesia.


This article has been cited by other articles:


Home page
 Br J AnaesthHome page
M. Licker, A. Spiliopoulos, and J. M. Tschopp
Influence of thoracic epidural analgesia on cardiovascular autonomic control after thoracic surgery
Br. J. Anaesth., October 1, 2003; 91(4): 525 - 531.
[Abstract] [Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 1998 by the Canadian Anesthesiologists' Society.