Orthostatic Dysregulation during Postural Change on the Dental Chair and Intraoperative Monitoring by Heart Rate Variability Analysis (original) (raw)
Related papers
2015
This is the first case report of well-managed postural orthostatic tachycardia syndrome (POTS) intraoperatively monitored by heart rate variability (HRV) analysis in dentistry. POTS-associated autonomic dysfunction is induced by postural changes and easily leads to disturbances in circulatory dynamics; however, most dental practices have not yet realized the importance of managing POTS. We measured autonomic activity in a patient with POTS during dental therapy and assessed the clinical significance of HRV analysis for POTS. The patient was a 40-year-old Japanese male. He was diagnosed with impacted wisdom teeth and was in treatment for bronchial asthma and POTS. A surgical procedure to extract the teeth was safely performed under local anesthesia. During the therapy, he developed neither orthostatic tachycardia nor compensatory hypotension in either the upright or supine position. HRV analysis revealed POTS-associated autonomic dysfunction, that is, autonomic instability during postural change. Thus HRV analysis should become a useful tool for safe and secure dental management of POTS.
Background: General anaesthesia causes decrease in both sympathetic & parasympathetic tone. Heart Rate variability (HRV) provides a powerful means of observing the interplay between sympathetic and parasympathetic nervous system. Reduced heart rate variability has been used as a marker of reduced vagal activity and is a valuable non-invasive tool in assessment of cardiovascular autonomic function. Objectives: To evaluate the autonomic tone in perioperative period during general anaesthesia by HRV. Methods: HRV was recorded for 5 minutes in supine position by using (CARDIART 8408 VIEW) HRV machine. Time domain (SDNN) analysis of HRV was done in the perioperative period. Reduced HRV is indicated by reduced SDNN. The results were statist ically analyzed using one way ANOVA & Post –Hoc Bonferroni criterion was used. Results: Post Hoc analysis indicated that SDNN was significantly lower in intraoperative period compared to the preoperative period. There was no significant difference betw...
The Effect of Orthostatic Hypotension Detected Pre‐Operatively on Post‐Operative Outcome
Journal of the American Geriatrics Society, 2020
BACKGROUND: Exacerbation of or new onset orthostatic hypotension in perioperative patients can occur. There is complex underlying pathophysiology with further derailment likely caused by acute cardiovascular changes associated with surgery. The implications for post-operative recovery are unclear, particularly in frail and older patients. We retrospectively explored patient notes for evidence of post-operative orthostatic intolerance in relation to preoperative orthostatic hypotension. METHODS: Supine and 1-minute and 3-minute standing blood pressure measures obtained from adult patients before mainly general, orthopedic or uro/gynecology surgery were compared to post-operative outcome, specifically, evidence in patient notes about falls, feeling dizzy/unsteady and/or fearful to stand. Orthostatic hypotension was defined as a 20 mmHg or more and/or 10 mmHg or more fall in systolic and diastolic blood pressure, respectively, within 3 minutes of standing after lying supine for an electrocardiogram. RESULTS: Whilst all patients included had a 1-minute standing blood pressure assessment (N = 170), 3-minute assessment was performed less commonly (N = 113). Nevertheless, one-quarter (23.5%; N = 40) of 170 patients had pre-operative orthostatic hypotension. This was not clearly explained by cardiac or neurological disease or by common medications, but did occur more frequently in older patients and in those aged 65 years or more with higher clinical frailty scale scores. The COVID-19 pandemic reduced the number of patients progressing to surgery within the planned study timescale (N = 143/170; 84.1%). Nevertheless, patients with orthostatic hypotension stayed longer in hospital post-operatively and were more likely to have an episode of fall, unsteadiness and/or dizziness documented (un-prompted) in their notes. CONCLUSIONS: These data provide further impetus for research into modifiable perioperative risk factors associated with orthostatic hypotension. These risks are not confined to those with a pre-existing dysautonomia diagnosis.
Regional Anesthesia and Pain Medicine, 1999
Background and Objectives. Heart rate variability (HRV), widely used as an indicator of activity of the autonomic nervous system, has been reported to decrease during and after both spinal and general anesthesia in patients without cardiovascular disease. We evaluated the changes in HRV bands in 40 patients with a high risk of ischemic heart disease. Methods. The patients were randomly assigned to receive either spinal (SA) or general anesthesia (GA) for elective total hip arthroplasty or peripheral vascular surgery. Anesthetic techniques and perioperative fluid administration were standardized. Holter monitoring was started preoperatively and continued until the third postoperative day. Three HRV frequency bands were analyzed. Results. A significant decrease was seen in very low frequency (VLF) and low frequency (LF) bands during GA but not during SA. Also the LF/high frequency (I-IF) ratio decreased during GA but not during SA. A decrease in all HRV frequency bands was seen after both types of anesthesia. None of the frequency bands returned back to the preoperative level during the 3-day trial. Postoperatively circadian variation was found only in the VLF band after SA. Conclusions. The sympathovagal balance (LF/HF) is more stable during SA than during GA in patients with a high risk of ischemic heart disease. The postoperative decrease in HRV bands, however, is independent of the anesthetic technique.
Rev. Cient. General José María Córdova, 2016
The aim of this paper is to analyze the autonomic behavior mediated by the baroreceptor response to an orthostatic maneuver (OM) in hypertensive and non-hypertensive subjects. The heart rate (HR) was obtained in 65 subjects (32 hypertensive and 33 non-hypertensive) using a frequency meter polar watch, before and after an OM (sudden standing). The R-R intervals were transformed into a heart rate, temporal series, and interpolation was applied due to a lack of heart rate periodicity. Sampling at 10Hz was performed, and a band-pass filter was applied followed by 1 Hz subsampling. The results showed an increase in sympathetic activity in the hypertensive group that did not occur in the non-hypertensive group after the OM (Δ%=59.84%, P<0.01). For the parasympathetic results, decreases were found only in the hypertensive group and not in the non-hypertensive group after the orthostatic intervention (Δ%= -43.4%, P<0.001). Increases in both groups were observed for the sympathovagal balance (hypertensive: Δ%= 45.63%, p=0.004; non-hypertensive: Δ%= 67.08%, p=0.013). The results showed increased sympathetic activity in contrast to a decreased parasympathetic response for hypertensive individuals after an OM [El proposito de este trabajo es analizar el comportamiento autonomico mediado por la respuesta barorreceptora a una maniobra ortostatica (MO) en sujetos hipertensos y no hipertensos. La frecuencia cardiaca (FC) fue obtenida en 65 sujetos (32 hipertensos y 33 no hipertensos) usando un monitor polar de frecuencia cardiaca, antes y despues de una MO (al ponerse de pie subitamente). Los intervalos R-R fueron transformados en series temporales (ST) de frecuencia cardiaca. Se aplico interpolacion debido a una falta de periodicidad en la ST de FC. Un muestreo de 10 Hz fue realizado, adicionalmente un filtro pasa banda seguida de un sub muestreo a 1 Hz. Los resultados mostraron un incremento en la actividad simpatica del grupo hipertenso, lo cual no ocurrio en el grupo no hipertenso luego de la MO (Δ%=59.84%, P<0.01). En cuanto a los resultados parasimpaticos se observaron disminuciones solamente en el grupo hipertenso y no en el grupo no hipertenso luego de la intervencion ortostatica (Δ%= -43.4%, P<0.001). Se observaron incrementos en ambos grupos para el balance simpatico vagal (hipertensos: Δ%= 45.63%, p=0.004; no hipertensos: Δ%= 67.08%, p= 0.013). Los resultados mostraron un incremento en la actividad simpatica en contraste con una disminucion de la respuesta parasimpatica en individuos hipertensos luego de una MO]
Orthostatic hypotension: definition, classification and evaluation
Blood Pressure, 2019
Purpose: Orthostatic hypotension (OH) is a common and clinically important disorder. Published papers vary regarding the definitions of OH and methodologies of evaluation. Moreover, substantial gaps in the skills and knowledge required for assessment of OH have been reported by clinicians. We aimed to provide current information regarding the definition, classification and evaluation of OH. Methods: We performed a comprehensive search of medical databases, using the following keywords: "postural hypotension" or "orthostatic hypotension", combined with: "definition", "classification", "diagnosis", "evaluation" or "meaning". We selected for this review the most relevant recent publications and key papers in the field, published in the English language. Results: Current data regarding definitions, classification and the evaluation of OH are reviewed. The various aspects of OH assessment are extensively discussed. Considerable discrepancies exist between the published guidelines regarding the methodology of OH diagnosing. We propose an algorithm for OH evaluation and a standardized protocol for bedside determination of OH by healthcare providers. Conclusions: Correct assessment of OH is essential for its accurate diagnosis. The methodology of OH evaluation has not been sufficiently standardized. We emphasize the clinical importance of the uniform investigation of OH, according to the current guidelines for OH definition and meaning.
BMC anesthesiology, 2015
Little is known about the changes in autonomic function during spinal anaesthesia in type 2 diabetic patients. The purpose of the study was to assess the influence of spinal anaesthesia on the heart rate variability in type 2 diabetic patients according to the glycated hemoglobin (HbA1c) level. Sixty-six patients who were scheduled for elective orthostatic lower limb surgery were assigned to three groups (n = 22, each) according to HbA1c; controlled diabetes mellitus (HbA1c < 7 %), uncontrolled diabetes mellitus (HbA1c > 7 %) and the control group. The heart rate variability was measured 10 min before (T0), and at10 min (T1), 20 min (T2) and 30 min (T3) after spinal anaesthesia. Before spinal anaesthesia, total, low-and high-frequency power were significantly lower in the uncontrolled diabetec group than in other group (p < 0.05). During spinal anaesthesia, total, low- and high-frequency powers were did not change in the uncontrolled diabetec group while the low-frequency p...