Continuous measurement of heart rate variability following carbon dioxide pneumoperitoneum during nitrous oxide/sevoflurane anaesthesia

Abstract

Background: Previous studies of autonomic nervous system activity through analysis of heart rate variability (HRV) have demonstrated increased sympathetic activity during positive-pressure pneumoperitoneum. We employed an online, continuous method for rapid HRV analysis (MemCalc™, Tarawa, Suwa Trust, Tokyo, Japan) to demonstrate rapid changes in autonomic nervous system during pneumoperitoneum for laparoscopy. Method: The powers of low-frequency (LF) (0.04-0.15 Hz) and high-frequency (HF) (0.15-0.4 Hz) components of HRV in 20 healthy adult patients were monitored under sevoflurane anaesthesia for 10 minutes after the initiation of carbon dioxide pneumoperitoneum at 10 mmHg. Results: Heart rate increased promptly, but transiently, just after peritoneal insufflation. At that time, the ratio between the LF and HF components increased on HRV. Similar, but small, changes occurred following head-up positioning. Conclusion: By monitoring HRV continuously, we have demonstrated that the change in autonomic nervous system balance induced by peritoneal insufflation was prompt and transient. The change in autonomic nervous system activity could have been due to increased sympathetic activity, reduced vagal activity, or both.

Keywords: heart rate variability; positive pressure pneumoperitoneum; continuous monitoring