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Heart rate variability dynamics during controlled hypotension with nicardipine, remifentanil and dexmedetomidine

 S. SHIN  ;  J. W. LEE  ;  S. H. KIM  ;  Y.-S. JUNG  ;  Y. J. OH 
 Acta Anaesthesiologica Scandinavica, Vol.58(2) : 168-176, 2014 
Journal Title
 Acta Anaesthesiologica Scandinavica 
Issue Date
Anesthesia, General ; Anesthetics, Inhalation ; Anesthetics, Intravenous/pharmacology* ; Antihypertensive Agents/pharmacology* ; Consciousness Monitors ; Dexmedetomidine/pharmacology* ; Electrocardiography/drug effects ; Female ; Heart Rate/drug effects* ; Humans ; Hypnotics and Sedatives/pharmacology* ; Hypotension, Controlled/methods* ; Male ; Methyl Ethers ; Nicardipine/pharmacology* ; Orthognathic Surgical Procedures ; Piperidines/pharmacology* ; Prospective Studies ; Sample Size ; Young Adult
BACKGROUND: This study was done to investigate how nicardipine, remifentanil and dexmedetomidine affect the balance of the autonomic nervous system in patients receiving controlled hypotension under general anaesthesia by evaluating heart rate variability indices. METHODS: Sixty-two patients were randomly allocated to either the nicardipine-sevoflurane (Group N, n = 21), remifentanil-sevoflurane (Group R, n = 21) or dexmedetomidine-sevoflurane (Group D, n = 20) group for controlled hypotension during orthognathic surgery. Electrocardiogram data acquisition was done after vital sign stabilization following anaesthesia induction (T1) and 30 min after controlled hypotension was induced (T2). RESULTS: Total power and low frequency (LF) power was significantly decreased at T2 compared with T1 in all groups, while a decrease in high frequency (HF) power was only observed in Group N (P < 0.001). LF/HF ratios of Group R and D were significantly suppressed at T2 compared with T1 (P = 0.001 and P < 0.001, respectively), but was increased Group N (P = 0.009). The LF/HF ratio of Group N was significantly higher than Group R and D at T2 (P < 0.001 in both), with Group D showing a significantly lower LF/HF ratio compared with Group R (P < 0.001). CONCLUSIONS: Remifentanil and dexmedetomidine did not have sympathetic nervous system-stimulating effects during controlled hypotension, while remifentanil seemed to be superior in preserving the overall balance in autonomic nervous system activity. Nicardipine was found to stimulate the sympathetic nervous system, which may be problematic in patients vulnerable to disturbances in the autonomic nervous system.
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
2. College of Dentistry (치과대학) > Dept. of Oral and Maxillofacial Surgery (구강악안면외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Shin Hyung(김신형) ORCID logo https://orcid.org/0000-0003-4058-7697
Shin, Seokyung(신서경) ORCID logo https://orcid.org/0000-0002-2641-0070
Oh, Young Jun(오영준) ORCID logo https://orcid.org/0000-0002-6258-5695
Lee, Jong Wha(이종화)
Jung, Young Soo(정영수) ORCID logo https://orcid.org/0000-0001-5831-6508
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