Non-invasive real-time autonomic function characterization during surgery via continuous Poincaré quantification of heart rate variability

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Autonomic function during anesthesia (n=36). Intervention: Propofol and fentanyl anesthesia vs. Resting controls. Primary outcome: Sympathetic (SD1) and parasympathetic (SD2) components of heart rate variability (p=0.019).

Maddalena Ardissino; Nicoletta Nicolaou; Marcela P. Vizcaychipi

doi:10.1007/s10877-018-0206-4

October 3, 2018Journal of Clinical Monitoring and ComputingOpen Access

Non-invasive real-time autonomic function characterization during surgery via continuous Poincaré quantification of heart rate variability

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Key result

Propofol and fentanyl anesthesia decreased both sympathetic and parasympathetic components of heart rate variability compared to baseline.

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Why the study?

Does continuous Poincaré quantification of HRV detect real-time autonomic function changes during propofol and fentanyl anesthesia in healthy individuals?

Study Design

Type

Observational (n=36)

Structured PICO

Does continuous Poincaré quantification of HRV detect real-time autonomic function changes during propofol and fentanyl anesthesia in healthy individuals?

P

Population

36 healthy individuals, comprising 18 patients aged 18-45 undergoing minor surgery under propofol anesthesia and 18 resting controls aged 21-35, monitored for heart rate variability.

E

Exposure

Propofol and fentanyl anesthesia with continuous heart rate monitoring via Poincaré quantification of heart rate variability (HRV) dynamics.

C

Comparator

Healthy controls at rest with continuous heart rate monitoring.

O

Outcome

Changes in sympathetic (SD1) and parasympathetic (SD2) components of HRV following anesthesia.surrogate

Main Result

p-value: p=0.019

Continuous Poincaré quantification of heart rate variability can successfully visualize real-time autonomic changes during anesthesia, providing a potential non-invasive monitoring tool at the point of care.

Limitations

Real-time analysis model was applied retrospectively to pre-collected data rather than live during surgery.
Analysis was based on pulse rate variability (PRV) from plethysmography rather than true HRV from ECG RR-intervals in the patient group.
Differences in recording methods between patients (finger plethysmography) and controls (12-lead ECG).
Potential confounding by operative events, fluid boluses, and cardioactive agents during surgery.
SD1 and SD2 variables obtained from HR and RR intervals are not directly comparable
Differences in recording methods (ECG vs plethysmography) may have given rise to intrinsic variation
Sampling frequency of 100 Hz is lower than the generally recommended >250 Hz
Needs comparison to other previously validated tools for ANS assessment
Impact of patient morbidity (e.g., heart failure) and cardioactive agents on HRV not investigated
Susceptibility to artefacts from surgical procedures (e.g., diathermy)

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Implication

Hypothesis-generating for autonomic suppression by propofol-fentanyl; prospective trials needed before clinical adoption.

Abstract

Heart rate variability (HRV) provides an excellent proxy for monitoring of autonomic function, but the clinical utility of such characterization has not been investigated. In a clinical setting, the baseline autonomic function can reflect ability to adapt to stressors such as anesthesia. No monitoring tool has yet been developed that is able to track changes in HRV in real time. This study is a proof-of-concept for a non-invasive, real-time monitoring model for autonomic function via continuous Poincaré quantification of HRV dynamics. Anonymized heart rate data of 18 healthy individuals (18-45 years) undergoing minor procedures and 18 healthy controls (21-35 years) were analyzed. Patients underwent propofol and fentanyl anesthesia, and controls were at rest. Continuous heart rate monitoring was carried out from before aesthetic induction to the end of the surgical procedure. HRV components (sympathetic and parasympathetic) were extracted and analyzed using Poincaré quantification, and a real-time assessment tool was developed. In the patient group, a significant decrease in the sympathetic and parasympathetic components of HRV was observed following anesthesia (SD1: p = 0.019; SD2: p = 0.00027). No corresponding change in HRV was observed in controls. HRV parameters were modelled into a real-time graph. Using the monitoring technique developed, autonomic changes could be successfully visualized in real-time. This could provide the basis for a novel, fast and non-invasive method of autonomic assessment that can be delivered at the point of care.

Discussion

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Cite This Study

Ardissino et al. (2018) conducted an observational in Autonomic function during anesthesia (n=36). Propofol and fentanyl anesthesia vs. Resting controls was evaluated on Sympathetic (SD1) and parasympathetic (SD2) components of heart rate variability (p=0.019). Propofol and fentanyl anesthesia decreased both sympathetic and parasympathetic components of heart rate variability compared to baseline.

synapsesocial.com/papers/6a707311af0c21e93928434e https://doi.org/10.1007/s10877-018-0206-4

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Non-invasive real-time autonomic function characterization during surgery via continuous Poincaré quantification of heart rate variability

Figures

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Non-invasive real-time autonomic function characterization during surgery via continuous Poincaré quantification of heart rate variability

Figures

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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