Effect of clonidine on heart rate variability during spinal anesthesia: randomized clinical trial

Introduction:All anesthetic techniques act, in some way, in the Autonomic Nervous System. In spinal anesthesia this effect is well described. The administration of local anesthetics in the subarachnoid space produces sensitive and sympathetic motor block, however, with latencies and variable and independent block levels. Adjuvants administered in association with local anesthetics have the potential to prolong the duration of spinal anesthesia, increasing the incidence of side effects. The recovery of spinal anesthesia is based solely on the return of motor function and does not take into account the recovery of Autonomic Nervous System activity.Objective:To analyze the autonomic modulation of heart rate in patients undergoing surgical procedures under spinal anesthesia at the moment of recovery of motor function and to compare the autonomic function in patients who received bupivacaine in subarachnoid anesthesia with patients who recover bupivacaine associated with clonidine. Method:randomized, double-blind clinical trial. The sample consisted initially of 71 patients ASA I to III, submitted to surgery under spinal anesthesia. Patients were divided into 2 groups. Group B received only bupivacaine and group C received bupivacaine with clonidine. The Heart Rate Variability was evaluated during 10 min in three moments: (T1) rest, before the anesthesia; (T2) 20 min after the installation of the anesthetic block, and (T3) at the time of recovery of motor function. Linear methods, frequency domain and non-linear methods in the Chaos domain were used. Results:The approximate entropy in the clonidine group showed a elevation, which may suggest a protective effect on the cardiovascular system of the addition of clonidine in spinal anesthesia. Conclusion:The approximate entropy values ​​at the moment of recovery of motor function in patients receiving spinal anesthesia with bupivacaine and clonidine present a reduction when compared to the values ​​obtained at rest. This data suggests that motor and autonomic block recovery occurs at different times when clonidine is used in spinal anesthesia. This data brings a question about the safety of the discharge criteria of the post anesthetic recovery room using only the return of the motor function after spinal anesthesia.

[1]  L. Vanderlei,et al.  Complex measurements of heart rate variability in obese youths: distinguishing autonomic dysfunction , 2018, Journal of Human Growth and Development.

[2]  V. Pandey,et al.  A Comparative Study of Intrathecal Bupivacaine and Bupivacaine with Different Doses of Clonidine in Lower Limb Surgeries , 2018, Anesthesia, essays and researches.

[3]  A. Habib,et al.  Spinal-induced hypotension: Incidence, mechanisms, prophylaxis, and management: Summarizing 20 years of research. , 2017, Best practice & research. Clinical anaesthesiology.

[4]  K. Nagase,et al.  Prediction of hypotension during spinal anesthesia for elective cesarean section by altered heart rate variability induced by postural change. , 2017, International journal of obstetric anesthesia.

[5]  V. Valenti.  The recent use of heart rate variability for research , 2015 .

[6]  S. Lee,et al.  Dynamics of heart rate variability in patients with type 2 diabetes mellitus during spinal anaesthesia: prospective observational study , 2015, BMC Anesthesiology.

[7]  S. Cerutti,et al.  Advances in heart rate variability signal analysis: joint position statement by the e-Cardiology ESC Working Group and the European Heart Rhythm Association co-endorsed by the Asia Pacific Heart Rhythm Society. , 2015, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[8]  L. Vanderlei,et al.  Heart rate dynamics by novel chaotic globals to HRV in obese youths , 2015 .

[9]  Kristin L Buterbaugh,et al.  Short-term complications in hip fracture surgery using spinal versus general anaesthesia. , 2015, Injury.

[10]  J. H. Kim,et al.  Heart rate variability as a predictor of hypotension after spinal anesthesia in hypertensive patients , 2013, Korean journal of anesthesiology.

[11]  J. Cwik.  Postoperative considerations of neuraxial anesthesia. , 2012, Anesthesiology clinics.

[12]  T. Komatsu,et al.  A greater decrease in blood pressure after spinal anaesthesia in patients with low entropy of the RR interval , 2007, Acta anaesthesiologica Scandinavica.

[13]  S. Brull,et al.  Spinal anesthesia , 2005, Current opinion in anaesthesiology.

[14]  P B Persson,et al.  Chaos in the cardiovascular system: an update. , 1998, Cardiovascular research.

[15]  J. Eisenach,et al.  Spinal anesthesia: Mechanisms, agents, methods, and safety☆ , 1998 .

[16]  R. Hughson,et al.  Sympathovagal Effects of Spinal Anesthesia Assessed by the Spontaneous Cardiac Baroreflex , 1997, Anesthesiology.

[17]  S. Marsch,et al.  Prolonged decrease in heart rate variability after elective hip arthroplasty. , 1994, British journal of anaesthesia.

[18]  M. Toptaş,et al.  A comparison of the effects of hyperbaric and isobaric bupivacaine spinal anesthesia on hemodynamics and heart rate variability. , 2014, Turkish journal of medical sciences.

[19]  V. Valenti,et al.  HEART RATE VARIABILITY IN HEALTHY ADOLESCENTS AT REST , 2012 .