Korean Journal of Anesthesiology

The Korean Society of Anesthesiologists (대한마취통증의학회)
권호 표지

The Changes of Differences of Pulse Transit Time between Toe and Finger in General and Epidural Anesthesia

전신마취 및 경막외 마취에서 손.발가락의 맥파전달시간차의 변화

Kim, Tae-Kyun;Cho, Ah-Reum;Choi, Byeong-Cheol;Baik, Seong-Wan
김태균;조아름;최병철;백승완

  • Published : 20070700
⟨ Previous Next ⟩

Abstract

Background: Pulse wave velocity (PWV) and pulse transit time (PTT) are influenced by the arterial wall stiffness and compliance. Also, the PTT is dependent on blood pressure changes that can be accompanied by the anesthesia. The simply measured PTT has difficult to discriminate the arterial compliance changes from blood pressure changes. Therefore, we investigated that the differences of PTT between toe and finger as an independent parameter on blood pressure. Methods: Eighteen patients scheduled for elective lower abdominal gynecologic surgery were studied. General anesthesia was achieved with sevoflurane and epidural block was done with 0.2% ropivacaine and fentanyl 100μg via epidural catheter inserted into L1－L2 epidural space. PTT was measured in a finger (PTTf) and a toe (PTTt) by the time difference between the ECG R wave and the pulse wave of PPG. Blood pressure and PTT was measured at three instances such as preinduction (Pre), 5 minutes after intubation (Int5) and 30 minutes after injection of epidural dose (Epi). The time delay of PTT between toe and finger (PTTt-f) was measured. Results: PTTf and PTTt was prolonged at Int5 and Epi. But the PTTt-f was not different between the Int5 and Epi because of prolonged PTTf caused by the blood pressure decrement after the epidural block. Conclusions: PTTf, PTTt and PTTt-f can be a one of the convenient measurement of the arterial compliance but it was suggested that there need to be a parameter less dependent on the blood pressure changes.

Keywords

References

  1. Lehmann ED: Clinical value of aortic pulse-wave velocity measurement. Lancet 1999; 354: 528-9 https://doi.org/10.1016/S0140-6736(99)00179-8
  2. Asmar R, Benetos A, Topouchian J, Laurent P, Pannier B, Brisac AM, et al: Assessment of arterial distensibility by automatic pulse wave velocity measurement. Validation and clinical application studies. Hypertension 1995; 26: 485-90 https://doi.org/10.1161/01.HYP.26.3.485
  3. Laurent S, Boutouyrie P, Asmar R, Gautier I, Laloux B, Guize L, et al: Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension 2001; 37: 1236-41 https://doi.org/10.1161/01.HYP.37.5.1236
  4. Rehman A, Ismail SB, Naing L, Roshan TM, Rahman AR: Reduction in arterial stiffness with angiotensin II antagonism and converting enzyme inhibition. A comparative study among malay hypertensive subjects with a known genetic profile. Am J Hypertens 2007; 20: 184-9 https://doi.org/10.1016/j.amjhyper.2006.07.015
  5. Tillin T, Chambers J, Malik I, Coady E, Byrd S, Mayet J, et al: Measurement of pulse wave velocity: site matters. J Hypertens 2007; 25: 383-9 https://doi.org/10.1097/HJH.0b013e3280115bea
  6. Hasegawa M, Nagao K, Kinoshita Y, Rodbard D, Asahina A: Increased pulse wave velocity and shortened pulse transmission time in hypertension and aging. Cardiology 1997; 88: 147-51 https://doi.org/10.1159/000177321
  7. Cwynar M, Gasowski J, Gryglewska B, Dubiel M, Grodzicki T: Pulse wave velocity in patients with coronary artery disease or type 2 diabetes mellitus. Acta Cardiol 2006; 61: 421-6 https://doi.org/10.2143/AC.61.4.2017303
  8. Baik SW, Park YS, Yae SY, Jeon GR, Choi BC, Jung DK: Effects of enflurane on pulse transit time. Korean J Anesthesiol 2004; 47: 17-22 https://doi.org/10.4097/kjae.2004.47.1.17
  9. Nitzan M, Khanokh B, Slovik Y: The difference in pulse transit time to the toe and finger measured by photoplethysmography. Physiol Meas 2002; 23: 85-93 https://doi.org/10.1088/0967-3334/23/1/308
  10. Shirai K, Utino J, Otsuka K, Takata M: A novel blood pressureindependent arterial wall stiffness parameter; cardio-ankle vascular index (CAVI). J Atheroscler Thromb 2006; 13: 101-7 https://doi.org/10.5551/jat.13.101
  11. Babchenko A, Davidson E, Adler D, Ginosar Y, Kurz V, Nitzan M: Increase in pulse transit time to the foot after epidural anasesthesia treatment. Med Biol Eng Comput 2000; 38: 674-9 https://doi.org/10.1007/BF02344874
  12. Pollak MH, Obrist PA: Aortic-radial pulse transit time and ECG Q-wave to radial pulse wave interval as indices of beat-by-beat blood pressure change. Psychophysiology 1983; 20: 21-8 https://doi.org/10.1111/j.1469-8986.1983.tb00895.x
  13. Pitson DJ, Sandell A, van den Hout R, Stradling JR: Use of pulse transit time as a measure of inspiratory effort in patients with obstructive sleep apnoea. Eur Respir J 1995; 8: 1669-74 https://doi.org/10.1183/09031936.95.08101669
  14. Drinnan MJ, Allen J, Murray A: Relation between heart rate and pulse transit time during paced respiration. Physiol Meas 2001; 22: 425-32 https://doi.org/10.1088/0967-3334/22/3/301
  15. Foo JY, Lim CS: Pulse transit time as an indirect marker for variations in cardiovascular related reactivity. Technol Health Care 2006; 14: 97-108
  16. Greenfield RH, Bessen HA, Henneman PL: Effect of crystalloid infusion on hematocrit and intravascular volume in healthy, nonbleeding subjects. Ann Emerg Med 1989; 18: 51-5 https://doi.org/10.1016/S0196-0644(89)80312-9
  17. Brauer KI, Svensen C, Hahn RG, Traber LD, Prough DS: Volume kinetic analysis of the distribution of 0.9% saline in conscious versus isoflurane-anesthetized sheep. Anesthesiology 2002; 96: 442-9 https://doi.org/10.1097/00000542-200202000-00033