Korean Journal of Anesthesiology

The Korean Society of Anesthesiologists (대한마취통증의학회)
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The effect of rocuronium on heart rate variability in diabetic patients

당뇨병 환자에서 Rocuronium이 심박수 변이도에 미치는 영향

Kong, Hyung-Youn;Lee, Jeong-Seok;Seo, Sang-Won;Cho, Sung-Hwan;Kim, Sang-Hyun;Chae, Won-Seok;Jin, Hee-Cheol;Kim, Yong-Ik
공형윤;이정석;서상원;조성환;김상현;채원석;진희철;김용익

  • Published : 20090800
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Abstract

Background: Clinically rocuronium, a muscle relaxant, has no significant inhibitory effect on the autonomic nervous system in the healthy population. However, there has been no study done on rocuronium in diabetic patients. Therefore, we used heart rate variability (HRV) as a biomarker to investigate cardiac autonomic function after rocuronium administration to diabetic patients. Methods: In 21 diabetic adult patients, heart rate (HR), mean arterial blood pressure (BP), low frequency (LF, 0.04−0.15 Hz) power, high frequency (HF, 0.15−0.4 Hz) power, LF/HF ratio, SD1 and SD2 in the Poincare plot before induction of anesthesia, and immediately before and after rocuronium administration were calculated and compared. Results: HR, mean BP, LF, LF/HF ratio and SD2 after rocuronium administration did not differ significantly from the measurements taken before rocuronium administration. HF and SD1 decreased significantly after rocuronium administration (P = 0.022, P = 0.019 respectively). Covariates such as age, gender, weight, duration of diabetes mellitus and hypertension did not alter the effect of rocuronium on the autonomic nervous system. Conclusions: Rocuronium produced a significant decrease in parasympathetic activity. Therefore, further study will be needed to determine whether vagal reduction caused by rocuronium could have potential to deteriorate hemodynamics in diabetic patients.

Keywords

References

  1. Vinik AI, Ziegler D. Diabetic cardiovascular autonomic neuropathy. Circulation 2007; 115: 387-97 https://doi.org/10.1161/CIRCULATIONAHA.106.634949
  2. American Diabetic Association. Standards of medical care in diabetes-2007. Diabetes Care 2007; 30(Suppl 1): S4-41 https://doi.org/10.2337/dc07-S004
  3. Park SK, Kang SJ, Im HS, Cheon MY, Bang JY, Shin WJ, et al. Validity of heart rate variability using poincare plot for assessing vagal tone during general anesthesia. Korean J Anesthesiol 2005; 49: 765-70 https://doi.org/10.4097/kjae.2005.49.6.765
  4. Tulppo MP, Makikallio TH, Takala TE, Seppanen T, Huikuri HV. Quantitative beat-to-beat analysis of heart rate dynamics during exercise. Am J Physiol 1996; 271: H244-52
  5. Vinik AI, Maser RE, Mitchell BD, Freeman R. Diabetic autonomic neuropathy. Diabetes Care 2003; 26: 1553-79 https://doi.org/10.2337/diacare.26.5.1553
  6. Liao D, Carnethon M, Evans GW, Cascio WE, Heiss G. Lower heart rate variability is associated with the development of coronary heart disease in individuals with diabetes: the atherosclerosis risk in communities (ARIC) study. Diabetes 2002; 51: 3524-31 https://doi.org/10.2337/diabetes.51.12.3524
  7. Maser RE, Lenhard MJ. Cardiovascular autonomic neuropathy due to diabetes mellitus: clinical manifestations, consequences, and treatment. J Clin Endocrinol Metab 2005; 90: 5896-903 https://doi.org/10.1210/jc.2005-0754
  8. Huang CJ, Kuok CH, Kuo TB, Hsu YW, Tsai PS. Pre-operative measurement of heart rate variability predicts hypotension during general anesthesia. Acta Anaesthesiol Scand 2006; 50: 542-8 https://doi.org/10.1111/j.1399-6576.2006.001016.x
  9. Sobotka PA, Liss HP, Vinik AI. Impaired hypoxic ventilatory drive in diabetic patients with autonomic neuropathy. J Clin Endocrinol Metab 1986; 62: 658-63 https://doi.org/10.1210/jcem-62-4-658
  10. Rajendra Acharya U, Paul Joseph K, Kannathal N, Lim CM, Suri JS. Heart rate variability: a review. Med Biol Eng Comput 2006; 44: 1031-51 https://doi.org/10.1007/s11517-006-0119-0
  11. Wray DW, Formes KJ, Weiss MS, O-Yurvati AH, Raven PB, Zhang R, et al. Vagal cardiac function and arterial blood pressure stability. Am J Physiol Heart Circ Physiol 2001; 281: H1870-80 https://doi.org/10.1152/ajpheart.2001.281.5.H1870
  12. Cho SK, Hwang GS, Kim YK, Huh IY, Hahm KD, Han SM. Low-dose atropine amplifies cardiac vagal modulation and increases dynamic baroreflex function in humans. Auton Neurosci 2005; 118: 108-15 https://doi.org/10.1016/j.autneu.2004.12.001
  13. Picker O, Scheeren TW, Arndt JO. Inhalation anaesthetics increase heart rate by decreasing cardiac vagal activity in dogs. Br J Anaesth 2001; 87: 748-54 https://doi.org/10.1093/bja/87.5.748
  14. Kanaya N, Hirata N, Kurosawa S, Nakayama M, Namiki A. Differential effects of propofol and sevoflurane on heart rate variability. Anesthesiology 2003; 98: 34-40 https://doi.org/10.1097/00000542-200301000-00009
  15. Sato K, Windisch K, Matko I, Vizi ES. Effects of non-depolarizing neuromuscular blocking agents on norepinephrine release from human atrial tissue obtained during cardiac surgery. Br J Anaesth 1999; 82: 904-9 https://doi.org/10.1093/bja/82.6.904
  16. Nagai H, Suzuki T, Katsumata N, Iwasaki K, Ogawa S, Suzuki H. Effect of non-depolarizing muscle relaxants on autonomic nervous system activity--assessment by heart rate variability analysis. Masui 1999; 48: 1294-301
  17. Miller RD. Miller's Anesthesia. 6th ed. Philadelphia, Churchill Livingstone. 2005, p 511
  18. Esler M, Skews H, Leonard P, Jackman G, Bobik A, Korner P. Age-dependence of noradrenaline kinetics in normal subjects. Clin Sci (Lond) 1981; 60: 217-9 https://doi.org/10.1042/cs0600217
  19. Antelmi I, de Paula RS, Shinzato AR, Peres CA, Mansur AJ, Grupi CJ. Influence of age, gender, body mass index, and functional capacity on heart rate variability in a cohort of subjects without heart disease. Am J Cardiol 2004; 93: 381-5 https://doi.org/10.1016/j.amjcard.2003.09.065
  20. Ramaekers D, Ector H, Aubert AE, Rubens A, Van de Werf F. Heart rate variability and heart rate in healthy volunteers. Is the female autonomic nervous system cardioprotective? Eur Heart J 1998; 19: 1334-41 https://doi.org/10.1053/euhj.1998.1084
  21. Jensen-Urstad K, Storck N, Bouvier F, Ericson M, Lindblad LE, Jensen-Urstad M. Heart rate variability in healthy subjects is related to age and gender. Acta Physiol Scand 1997; 160: 235-41 https://doi.org/10.1046/j.1365-201X.1997.00142.x
  22. Kuo TB, Lin T, Yang CC, Li CL, Chen CF, Chou P. Effect of aging on gender differences in neural control of heart rate. Am J Physiol 1999; 277: H2233-9
  23. Takahashi N, Nakagawa M, Saikawa T, Ooie T, Yufu K, Shigematsu S, et al. Effect of essential hypertension on cardiac autonomic function in type 2 diabetic patients. J Am Coll Cardiol 2001; 38: 232-7 https://doi.org/10.1016/S0735-1097(01)01363-8
  24. Athyros VG, Didangelos TP, Karamitsos DT, Papageorgiou AA, Boudoulas H, Kontopoulos AG. Long-term effect of converting enzyme inhibition on circadian sympathetic and parasympathetic modulation in patients with diabetic autonomic neuropathy. Acta Cardiol 1998; 53: 201-9
  25. Ondocin PT, Narsipur SS. Influence of angiotensin converting enzyme inhibitor treatment on cardiac autonomic modulation in patients receiving haemodialysis. Nephrology (Carlton) 2006; 11: 497-501 https://doi.org/10.1111/j.1440-1797.2006.00680.x
  26. Takase B, Takeishi Y, Hirai T, Lee JD, Uzui H, Senda S, et al. Comparative effects of amlodipine monotherapy and combination therapy with betaxolol on cardiac autonomic nervous activity and health-related quality of life in patients with poorly controlled hypertension. Circ J 2008; 72: 764-9 https://doi.org/10.1253/circj.72.764
  27. Piccirillo G, Vetta F, Viola E, Santagada E, Ronzoni S, Cacciafesta M, et al. Heart rate and blood pressure variability in obese normotensive subjects. Int J Obes Relat Metab Disord 1998; 22: 741-50 https://doi.org/10.1038/sj.ijo.0800650

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