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L’hyperréflexie autonome induite par la stimulation des racines sacrées est détectée par l’analyse spectrale de l’ECG

[Autonomic hyperreflexia induced by sacral root stimulation is detected by spectral analysis of the EEG]

Musa Sesay, MD^*, Jean-Rodolphe Vignes, MD, Dominique Liguoro, MD PhD, Philippe Crozat, MD^*, Géry Boulard, MD^*, Jean Guerin, MD, Michel Barat, MD and Pierre Maurette, MD^*

^* Du Département d’Anesthésie-réanimation 3, Service de Neurochirurgie A, et Service de Rééducation neurologique,
Centre Hospitalier Universitaire Pellegrin, Bordeaux France.

Adresser la correspondance à : Dr Musa Sesay, Unité de Neuroanesthésie réanimation, Département d’anesthésie- réanimation 3, Centre Hospitalier Universitaire Pellegrin, 33076 Bordeaux cedex, France. Téléphone: 05 56 79 55 43; Télécopieur: 05 56 79 61 55; Courriel: musa.sesay{at}chu-bordeaux.fr

Purpose: To compare spectral analysis of the electrocardiogram (ECG) with mean arterial pressure (MAP) and heart rate (HR) monitoring in the detection of autonomic hyperreflexia (AHR) induced by sacral root stimulation.

Methods: Ten spinal cord injured patients scheduled for implantation of a sacral root stimulator for bladder retention were included. Under target controlled anesthesia with propofol 4 µg•mL^–1 and remifentanil 4 ng•mL^–1, the patients were placed in the knee chest position. The sacral roots were exposed by laminectomy (L2–S1) and their function assessed by electrostimulation under urodynamic and cardiovascular monitoring. Online power spectrum densities were calculated from the ECG R-R interval by the MemCalc^TM software using the maximum entropy method. Low frequency (LF: 0.04–0.15 Hz) and high frequency (HF: 0.15–0.4 Hz) spectra were associated with sympathetic and parasympathetic activities respectively. The most extreme value of each variable was noted before and during each stimulation. A difference () of more than 10% signified AHR. The comparison (LF vs MAP and HF vs HR) was done by a concordance test with a kappa coefficient (k): -1 = total discordance to 1 = total concordance.

Results: AHR was detected in six patients as an increase in LF and MAP (n = 4); an increase in LF, HF, MAP with a decrease in HR (n = 2). The detection delay was 5.3 ± 1 sec (LF, HF) and 10.4 ± 1.2 sec (MAP and HR).Concordance was 85% (LF vs MAP: k = 0.7) and 90% (HF vs HR: k = 0.8).

Conclusion: AHR induced by sacral root stimulation is detected by spectral analysis of the ECG earlier than MAP and HR. Other studies are needed to confirm these results.

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