Key result
Pneumoperitoneum and Trendelenburg position during laparoscopy-assisted vaginal hysterectomy significantly increased sympathetic activation, indicated by higher normalized low-frequency heart rate variability compared to pre-pneumoperitoneum.
Why the study?
Does pneumoperitoneum and Trendelenburg position alter autonomic nervous system activity in patients undergoing laparoscopy-assisted vaginal hysterectomy?
Observational (n=22)
Yes
Does pneumoperitoneum and Trendelenburg position alter autonomic nervous system activity in patients undergoing laparoscopy-assisted vaginal hysterectomy?
Absolute Event Rate: 0.82% vs 0.64%
p-value: p=<0.05
Pneumoperitoneum and Trendelenburg position during laparoscopy-assisted vaginal hysterectomy cause significant sympathetic activation, highlighting the need for careful autonomic monitoring in high-risk patients.
Sympathetic activation during laparoscopy may inform monitoring in high-risk patients; leaves open effects on clinical outcomes.
BACKGROUND: This study was designed to assess the effects of pneumoperitoneum and positional changes on the autonomic nervous system (ANS) in laparoscopy-assisted vaginal hysterectomy (LAVH) patients. METHODS: Systolic blood pressures and R-R interval were recorded for 5 minutes in 22 patients, and then power spectral analyses were conducted to evaluate the ANS. The following variables were measured at various positions: preinduction (BASE), prepneumoperitoneum (PREPP), pneumoperitoneum at head-down (PP), normoperitoneum at supine (POSTPP). RESULTS: High frequency of heart rate variability (HRVHF), Low frequency of heart rate variability (HRVLF), Low frequency of blood pressure variability (BPVLF), LF/HF ratios of HRV (LFHFr) were significantly lower than that of BASE at PREPP. HRVHF, HRVLF, BPVLF were significantly lower than that of BASE at PP. At PP, normalized HF of HRV (nuHF) is significantly lower than that of BASE and normalized LF of HRV (nuLF) is significantly higher than that of BASE and PREPP (P < 0.05). LFHFr was significantly lower than that of BASE and significantly higher than that of PREPP at PP. At POSTPP, HRVHF, HRVLF, BPVLF were significantly lower than that of BASE. But, BPVLF at POSTPP was higher than that of PP. CONCLUSIONS: We conclude that the pneumoperitoneum and trendelenburg positions caused sympathetic activation in LAVH patients.
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Chang et al. (2009) conducted an observational in Laparoscopy-assisted vaginal hysterectomy (n=22). Pneumoperitoneum and Trendelenburg position vs. Pre-pneumoperitoneum was evaluated on Normalized low frequency of heart rate variability (nuLF) (p=<0.05). Pneumoperitoneum and Trendelenburg position during laparoscopy-assisted vaginal hysterectomy significantly increased sympathetic activation, indicated by higher normalized low-frequency heart rate variability compared to pre-pneumoperitoneum.
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