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Cardiothoracic and Vascular Anesthesia
Anesthesia and Pain Medicine 2012;7(1):45-50.
Published online January 31, 2012.
Heart rate variability predicts the extent of corrected QT interval prolongation after tracheal intubation
Ji Young Kim, Yon Hee Shim, Seung Ho Choi, Sung Yeon Ham, Dong Woo Han
1Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea.
2Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Corrected QT (QTc) interval can be modulated by sympathetic and parasympathetic balance. Tracheal intubation causes significant prolongation of the QTc interval due to sympathetic stimulation. This study was designed to elucidate the relationship between baseline autonomic nervous system activity and QTc prolongation after endotracheal intubation using heart rate variability (HRV).
Sixty-six healthy patients were included and the baseline HRV data were recorded for 5 min before anesthesia. Power spectrum densities were calculated for low frequencies (LF, 0.04-0.15 Hz) and high frequencies (HF, 0.15-0.4 Hz), defined as either LF's or HF's relative part of the total power. Anesthesia was induced with sevoflurane and vecuronium was given. The QTc interval, heart rate (HR) and mean arterial pressure (MAP) were measured before induction (baseline), before laryngoscopy (pre-intubation) and immediately after the intubation (post-intubation).
The QTc interval change at post-intubation from baseline (DeltaQTc) showed a significant negative correlation with the HF (r = 0.34, P = 0.006) and positive correlation with LF/HF ratio (r = 0.37, P = 0.005). Patients were retrospectively divided into low-HF/LF (<2.5, n = 44) and high-HF/LF group (>2.5, n = 22). The DeltaQTc was statistically higher in the high-LF/HF group compared to that in the low-LF/HF group (P = 0.048). The HR and MAP at baseline, pre-intubation and post-intubation were not different between two groups.
The QTc interval prolongation after endotracheal intubation is influenced by baseline autonomic conditions and can be exaggerated in patients with activated sympathetic activity or depressed parasympathetic activity.
Key Words: Autonomic nervous system, Corrected QT interval, Heart rate variability, Intubation
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