Wujtewicz Magdalena, Twardowski Paweł, Jasiński Tomasz, Raczyńska Dorota, Owczuk Radosław
Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Medical University of Gdańsk, Smoluchowskiego 17, 80-214, Gdańsk, Poland.
Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, 201 Great King Street, Dunedin, 9016, New Zealand.
Ophthalmol Ther. 2022 Oct;11(5):1857-1867. doi: 10.1007/s40123-022-00549-0. Epub 2022 Aug 1.
Ophthalmic surgery is assumed to be safe, but some operations require general anaesthesia which is associated with a number of potential complications. In addition, adverse cardiovascular symptoms, such as severe slowing of the heart rate and, in some cases, cardiac arrest may occur due to the surgical technique. The aim of this study was to determine whether it is possible to predict the occurrence of oculocardiac reflex (OCR) based on heart rate variability (HRV) analysis for autonomic nervous system (ANS) activity assessment measured prior to the induction of anaesthesia and immediately before eyeball traction.
Fifty-two adults of both sexes (age range 18-65 years) with American Society of Anesthesiologists (ASA) physical status class 1 and 2 were enrolled in this study. All patients had underwent episcleral buckling under general anaesthesia. High-frequency (HF) changes in HRV are thought to reflect parasympathetic impulse transmission, whereas low-frequency (LF) changes reflect both sympathetic and parasympathetic activity. However, in practice, LF changes can be considered to reflect sympathetic changes. Thus, the LF/HF ratio reflects the actual balance between sympathetic and parasympathetic activity. Based on that, frequency domain HRV parameters from 5-min Holter electrocardiogram recordings before anaesthesia induction and before eyeball traction were used for the analysis. The statistical analysis also included patient age, sex, ASA status and preanaesthesia and premanoeuvre heart rate and blood pressure.
Data from 42 patients were analysed. Oculocardiac reflex was observed in 32 patients (76.2%). No difference was found in the analysed parameters between patients with and without oculocardiac reflex. There was no relationship between the incidence of the OCR and the analysed parameters.
The prediction of OCR based on initial ANS tone was not possible, and the initial heart rate, blood pressure, age, sex, and ASA status were not helpful for the identification of patients at risk of this reflex.
ClinicalTrials.gov identifier no.: NCT01714362.
眼科手术通常被认为是安全的，但有些手术需要全身麻醉，而这会带来一些潜在并发症。此外，由于手术操作技术的原因，可能会出现不良心血管症状，如心率严重减慢，在某些情况下还会发生心脏骤停。本研究的目的是确定基于麻醉诱导前和眼球牵引前测量的自主神经系统（ANS）活动评估的心率变异性（HRV）分析，是否能够预测眼心反射（OCR）的发生。
本研究纳入了52名年龄在18 - 65岁之间、美国麻醉医师协会（ASA）身体状况分级为1级和2级的成年男女。所有患者均在全身麻醉下接受巩膜外加压术。HRV的高频（HF）变化被认为反映副交感神经冲动传递，而低频（LF）变化反映交感神经和副交感神经活动。然而，在实际应用中，LF变化可被视为反映交感神经变化。因此，LF/HF比值反映了交感神经和副交感神经活动之间的实际平衡。基于此，使用麻醉诱导前和眼球牵引前5分钟动态心电图记录的频域HRV参数进行分析。统计分析还包括患者的年龄、性别、ASA分级以及麻醉前和操作前的心率和血压。
分析了42名患者的数据。32名患者（76.2%）观察到眼心反射。有无眼心反射的患者在分析参数上未发现差异。OCR的发生率与分析参数之间没有关系。
基于初始ANS张力预测OCR是不可能的，初始心率、血压、年龄、性别和ASA分级对识别有这种反射风险的患者没有帮助。
ClinicalTrials.gov标识符：NCT01714362。
