Balaji Rohini Mayur, Nagaraja P S, Singh Naveen G, Prabhakar V, Manjunatha N
Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India.
Ann Card Anaesth. 2019 Jan-Mar;22(1):101-106. doi: 10.4103/aca.ACA_9_18.
: Autonomic dysfunction (AD) is infrequently evaluated preoperatively despite having profound perioperative implications. The ANSiscope™ is a monitoring device that quantifies AD. This study aims to determine the potential of the device to predict hypotension following anesthetic induction, occurrence of arrhythmias, and inotrope requirement for patients undergoing off-pump coronary artery bypass surgery (OPCAB).
: Prospective observational double-blinded study.
Seventy-five patients undergoing OPCAB had their autonomic function assessed by ANSiscope™. They were classified into four groups based on their AD and compared to perioperative adverse events.
Patients with diabetes had a higher ANSindex (P = 0.0263). They had a greater decrease in systolic blood pressure (P = 0.001) and mean arterial pressure (P = 0.004) postinduction, had an increased incidence of arrhythmias (P = 0.009), required higher inotropic support immediately (P = 0.010) and at 24 h after surgery (P = 0.018), and longer duration of postoperative ventilation (P < 0.001). They also had a higher incidence of emergency conversion of OPCAB to on-pump surgery (P = 0.009).
An increased association between AD as quantified by the ANSiscope™ and perioperative adverse outcomes was observed. An increased rate of emergency conversion of OPCAB to on-pump surgery with higher dysfunction was noted. The authors opine that the threshold for conversion must be lower in patients deemed to be at a higher risk. Proper evaluation of the autonomic nervous system empowers the anesthesiologist to anticipate and adequately prepare for complications.
尽管自主神经功能障碍（AD）对围手术期有深远影响，但术前很少对其进行评估。ANSiscope™是一种用于量化AD的监测设备。本研究旨在确定该设备对非体外循环冠状动脉搭桥手术（OPCAB）患者麻醉诱导后低血压、心律失常的发生以及血管活性药物需求的预测潜力。
前瞻性观察双盲研究。
75例行OPCAB的患者通过ANSiscope™评估其自主神经功能。根据AD情况将他们分为四组，并与围手术期不良事件进行比较。
糖尿病患者的ANS指数较高（P = 0.0263）。他们诱导后收缩压（P = 0.001）和平均动脉压（P = 0.004）下降幅度更大，心律失常发生率增加（P = 0.009），术后立即（P = 0.010）和术后24小时（P = 0.018）需要更高剂量的血管活性药物支持，术后机械通气时间更长（P < 0.001）。他们从OPCAB紧急转为体外循环手术的发生率也更高（P = 0.009）。
观察到通过ANSiscope™量化的AD与围手术期不良结局之间的关联增加。注意到OPCAB紧急转为体外循环手术的发生率随着功能障碍程度的增加而升高。作者认为，对于被认为风险较高的患者，转换阈值必须更低。对自主神经系统进行适当评估可使麻醉医生预测并发症并做好充分准备。
