Different effects on circulatory control during volatile induction and maintenance of anesthesia and total intravenous anesthesia: autonomic nervous activity and arterial cardiac baroreflex function evaluated by blood pressure and heart rate variability analysis

Abstract

Study Objective To evaluate the different effects on autonomic circulatory control during volatile induction/maintenance of anesthesia (VIMA) vs total intravenous anesthesia (TIVA). Design Prospective study. Setting Operating theater of a university hospital. Patients Twenty patients, with American Society of Anesthesiologists physical status of I or II, were randomly allocated into the VIMA group (n = 10) or the TIVA group (n = 10). Interventions In the VIMA group, anesthesia was induced with 5% sevoflurane and 60% N 2O in oxygen and maintained with 2% sevoflurane and 60% N 2O in oxygen. In the TIVA group, anesthesia was induced with propofol 2.0 mg/kg intravenously by bolus injection and fentanyl 2 μg/kg, and maintained with an intravenous infusion of propofol 5 mg/kg·per hour and air-oxygen mixture. Measurements Monitoring included recordings of electrocardiographic and arterial blood pressure waveforms. Autonomic nervous activity and arterial cardiac baroreflex function were evaluated by analysis of blood pressure variability, heart rate variability, and transfer function analysis between these 2 variables. Main Results In the VIMA group, the low-frequency component of blood pressure variability (LF SBP) and low- and high-frequency components of the R-R interval variability (LF RR and HF RR) decreased significantly during anesthesia. In the TIVA group, LF SBP and LF RR decreased significantly. The degree of reduction in LF SBP was greater in the VIMA group than in the TIVA group. However, changes in R-R interval variability and cardiac baroreflex indices were not significantly different between the 2 groups. Conclusions Our results demonstrated that although reductions in autonomic nervous modulation to the heart might not be so different between the 2 groups, reduction in sympathetic nervous modulation to peripheral vasculature is greater in the VIMA group than in the TIVA group.