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Korean Journal of Anesthesiology 2006;50(6):663-673.
DOI: https://doi.org/10.4097/kjae.2006.50.6.663   
Changes in Heart Rate Variability in Elderly Hypertensive Patients during Combined Spinal-Epidural Anesthesia.
Mi Suk Kwon, Hee Jung Baik, Yoon Jin Kim, Jong Hak Kim
1Department of Anesthesiology and Pain Medicine, Gangseo Songdo Hospital, Korea.
2Department of Anesthesiology and Pain Medicine, Ewha Womans University College of Medicine, Seoul, Korea. baikhj@ewha.ac.kr
We evaluated the changes in heart rate variability (HRV) in elderly patients with or without hypertension before and after combined spinal-epidural anesthesia (CSE).
Elderly hypertensive (group H, n = 28) and non-hypertensive patients (group C, n = 32) were recruited. We analyzed the spectral components of HRV, total power (< or = 0.4 Hz), low and high frequency power expressed as natural logarithm (LnTP, LnLF, and LnHF), normalized HF (HFnorm), normalized LF (LFnorm), and LF/HF ratio, from 5-minute electrocardiography recordings. We also measured blood pressures (systolic; SBP, diastolic; DBP, mean; MAP), heart rate (HR) and analgesia level before and after CSE. Each group was divided into two subgroups (< or = T7 [L] or > or = T6 [H]) according to fixed analgesia level.
Before CSE, group H showed significantly lower LnLF than that of group C (P < 0.05). Fifteen and 10 min after CSE, decrease of SBP and increase of HR in group HH were significantly greater compared with group CL and lesser with group CH, respectively. LnTP, LnLF and LnHF in both control groups (CL and CH) were significantly decreased 15-20 min after CSE compared with pre-CSE values. LnLF and LnHF in group HH were significantly lower than those in group HL 10-15 min after CSE. But there were no significant changes of LFnorm, HFnorm and LF/HF in all four groups.
The group H showed significantly lower LnLF than that of group C before CSE. In group HH, LnLF and LnHF were significantly lower than those in group HL 10-15 min after CSE, but the balance of the autonomic nervous system was not changed significantly.
Key Words: combined spinal-epidural anesthesia; elderly patient; heart rate variability; hypertension


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