Vegetative Balance under Epidural Anesthesia

M.O. Harbar, Y.О. Svitlyk, H.V. Svitlyk, Y.М. Pighirnyi

Abstract


Background. Anesthesia is accompanied by imbalance of sympathetic and parasympathetic effects on the cardiovascular system. Heart rate variability describes the typical changes in intervals between heart contractions of normal sinus rhythm and is a non-invasive method for assessment of the autonomic nervous system, which does not require expensive and cumbersome equipment. External influences on organism are reflected in changes of heart rate variability and mostly caused by the sympathetic and parasympathetic autonomic influences on the heart. We consider that the method of heart rate variability evaluation is simple and easy to interpret and due to this requires wider application in clinical practice. The aim of our study was to assess the features of heart rate variability in a narrow period — the time of surgery. Materials and methods. The study involved 26 males aged from 40 to 69 years who have had surgery on inguinal hernia under epidural anesthesia. Taking into account the relationship between heart rate variability parameters and age, patients were divided into two groups: the first one included persons aged 40–59 years, the second one consisted of the patients aged 60–79 years. Results. Compared with the control group in all examined individuals during surgery strengthening of parasympathetic tone of heart rate occurred. This feature was more pronounced in the patients older 60 years old. In the patients of I group pNN50 parameter has increased significantly, the value of high frequency (HF) — insignificantly, on the contrary low frequency (LF) contribution was slightly decreased (tendency to reducing the sympathetic influence and average values of LF in the development of epidural anesthesia were also identified by other researchers). This led to a decrease in sympatho-vagal index. In the patients of group II significant increasing of pNN50 was observed. The peculiarity for this group was triple growth of sympathetic tone on the example of LF. However, due to a marked increase (almost fivefold) of parasympathetic activity (on the example of HF), sympatho-vagal index significantly decreased by 36.75 %. Our attention was attracted to statistically significant reduction in the value of VLF in the patients of group I as compared to the same age category of the control group, indicating some leveling of humoral influence on heart rate variability. Also activity of humoral factor decreases in parallel to an increasing of surgery duration. Correlation analysis identified elongation of QTc interval with increasing of patients’ age and a logical reduction of humoral influences on heart rate variability and increasing of parasympathetic tone. Conclusions. We can conclude that in younger people generally described tendency to sympathectomy remains as a result of influence of local anesthetic. The people over 60 years old were found to have activated sympathetic and parasympathetic tone, but the advantage of the last resulted in a statistically significant reduction in sympatho-vagal index. Thus surgery under epidural anesthesia was characterized by harmonious changes of sympatho-vagal tone with insignificant advantage of parasympathetic tone activation in individuals over 60 years old that is a sign of safety and adequacy of epidural anesthesia.


Keywords


epidural anesthesia; intraoperative period; heart rate variability

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DOI: https://doi.org/10.22141/2224-0586.8.79.2016.90380

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