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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2015 January;81(1):3-11
Autonomic cardiovascular modulation with three different anesthetic strategies during neurosurgical procedures
Guzzetti S. 1, Bassani T. 2, Latini R. 3, Masson S. 3, Barlera S. 3, Citerio G. 4, Porta A. 5 ✉
1 Department of Emergency Medicine “Luigi Sacco” Hospital, Milan, Italy;
2 Internal Medicine, Clinical and Research Center, IRCCS Humanitas Clinical Institute, Rozzano, Milan, Italy;
3 Department of Cardiovascular Research, IRCCS, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy;
4 Neuroanaesthesia and Neurointensive Care Unit, Anestesia e Rianimazione, San Gerardo Hospital, Monza, Italy;
5 Department of Biomedical Sciences for Health, Galeazzi Orthopedic Institute, University of Milan, Milano, Italy
BACKGROUND: Autonomic cardiovascular modulation during surgery might be affected by different anesthetic strategies. Aim of the present study was to assess autonomic control during three different anesthetic strategies in the course of neurosurgical procedures by the linear and non-linear analysis of two cardiovascular signals.
METHODS: Heart rate (EKG-RR intervals) and systolic arterial pressure (SAP) signals were analyzed in 93 patients during elective neurosurgical procedures at fixed points: anesthetic induction, dura mater opening, first and second hour of surgery, dura mater and skin closure. Patients were randomly assigned to three anesthetic strategies: sevoflurane+fentanyl (S-F), sevoflurane+remifentanil (S-R) and propofol+remifentanil (P-R).
RESULTS: All the three anesthetic strategies were characterized by a reduction of RR and SAP variability. A more active autonomic sympathetic modulation, as ratio of low to high frequency spectral components of RR variability (LF/HF), was present in the P-R group vs. S-R group. This is confirmed by non-linear symbolic analysis of RR series and SAP variability analysis. In addition, an increased parasympathetic modulation was suggested by symbolic analysis of RR series during the second hour of surgery in S-F group.
CONCLUSION: Despite an important reduction of cardiovascular signal variability, the analysis of RR and SAP signals were capable to detect information about autonomic control during anesthesia. Symbolic analysis (non-linear) seems to be able to highlight the differences of both the sympathetic (slow) and vagal (fast) modulation among anesthetics, while spectral analysis (linear) underlines the same differences but only in terms of balance between the two neural control systems.