Document Detail


Autonomic nervous system response to epidural analgesia in laboring patients by wavelet transform of heart rate and blood pressure variability.
MedLine Citation:
PMID:  15220767     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Epidurals are effective in relieving labor pain but result in a sympathectomy that may compromise maternal hemodynamic stability and fetal perfusion. Decreases in blood pressure and heart rate can be corrected, but markers of autonomic activity would be useful to predict and prevent such changes. The goal of this study was to find markers describing the changes in autonomic nervous system activity with epidural anesthesia in laboring patients. METHODS: The authors analyzed heart rate variability and blood pressure variability in 13 laboring patients using wavelet transform, a time-frequency analysis that accommodates rapid changes in autonomic activity. Heart rate and blood pressure variability were obtained 5 min before and 10 min after injection of 20 ml bupivacaine, 0.125%, and 50 microg fentanyl in the epidural space. RESULTS: Blood pressure and heart rate were not affected by epidural analgesia. However, high-frequency power of heart rate variability increased after epidural (increase in parasympathetic drive). The ratio of low-frequency:high-frequency power of heart rate variability decreased. High- and low-frequency power of blood pressure variability decreased (decrease in sympathetic outflow). CONCLUSIONS: Indices of parasympathetic and sympathetic activity after neuraxial blockade in laboring patients can be obtained by analysis of both heart rate variability and blood pressure variability. The analysis by wavelet transform can discern changes in autonomic activity when values of blood pressure and heart rate do not vary significantly. Whether this technique could be used to predict and prevent hemodynamic compromise after neuraxial blockade merits further studies.
Authors:
Alain Deschamps; Ian Kaufman; Steven B Backman; Gilles Plourde
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Anesthesiology     Volume:  101     ISSN:  0003-3022     ISO Abbreviation:  Anesthesiology     Publication Date:  2004 Jul 
Date Detail:
Created Date:  2004-06-28     Completed Date:  2004-07-29     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  21-7     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesiology, McGill University Health Centre, Royal Victoria Hospital, Quebec, Canada. alain.deschamps@staff.mcgill.ca
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MeSH Terms
Descriptor/Qualifier:
Adult
Analgesia, Epidural / adverse effects*
Analgesia, Obstetrical / adverse effects*
Autonomic Nervous System / drug effects*
Blood Pressure / drug effects*
Data Interpretation, Statistical
Electrocardiography
Female
Heart Rate / drug effects*
Humans
Monitoring, Intraoperative
Parasympathetic Nervous System / drug effects,  physiology
Pregnancy
Respiratory Mechanics / physiology
Sympathetic Nervous System / drug effects,  physiology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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