Features of the heart rate variability in the perioperative period after adenotomy in children

Authors

  • Михайло Борисович Пушкар Kharkiv Medical Academy of Postgraduate Education st. Korchagintsev, 58, Kharkiv, Ukraine, 61176, Ukraine

DOI:

https://doi.org/10.15587/2313-8416.2015.39181

Keywords:

adenotomy, intravenous anesthesia, inhalation anesthesia, heart rate variability, pain

Abstract

Aim. Study course of perioperative period after adenotomy in children in different ways of general anesthesia by examining indicators of heart rate variability and efficacy of postoperative analgesia.

Materials and methods. To study included 70 children aged from 6 to 8 years, which was held adenotomy. Patients were divided into 3 groups: group I (n = 28) - operated under conditions of intravenous anesthesia based on propofol combined with fentanyl; group II (n=23) – operated under conditions of inhalation anesthesia by sevoflurane in combination with fentanyl and analginum; group III (n=19) – operated under conditions of intravenous anesthesia based on thiopental sodium combined with fentanyl. Differences were considered significant at p <0.05 using Student t-test.

Results. Indicators of heart rate variability indicated that in the extubation stage in all groups of patients revealed high activity of the sympathetic tone with the trend of decline in the morning after surgery. Statistically higher activity of the sympathetic part of the autonomic nervous system was in patients of group III - 1 hour after surgery compared with patients groups I and II (p <0,001 and p <0,01, respectively). After 1 hour after surgery on the scales "Faces" and "Oucher" scores indicated that the child "a little hurt" in all groups of patients In the dynamics of observation in all groups tended to reduce the intensity of pain. An interpretation of scores on the FLACC scale indicated that patients in both groups felt comfortable.

Conclusions. It was found that in patients in all groups there are changes in the nervous regulation of heart rate variability, characterized by increased activity of the sympathetic division of the autonomic nervous system. Postoperative anesthesia by 10 mg / kg ibuprofen provides effective analgesia

Author Biography

Михайло Борисович Пушкар, Kharkiv Medical Academy of Postgraduate Education st. Korchagintsev, 58, Kharkiv, Ukraine, 61176

Postgraduate student

The department of pediatric anesthesiology and intensive care

References

Baevskij, R. M. (2004). Analiz variabel'nosti serdechnogo ritma: istorija i filosofija, teorija i praktika [Analysis of the heart rate variability: the history and philosophy, theory and practice]. Klinicheskaja informatika i telemedicina, 1, 54–64.

Pediatric Pain Management. Available at: http://www.emoryhealthcare.org/saint-josephs-hospital-atlanta/health professionals/cme/pdf/ama_painmgmt_m6 2010.pdf

Zil'ber, A. P. (1994). Klinicheskaja fiziologija v anesteziologii i reanimatologii [Clinical physiology in anesthesiology and intensive care]. Moscow, Russia: Medicina, 113–124.

Rjabov, G. A. (1994). Sindromy kriticheskih sostojanij [Syndromes of critical states]. Moscow, Russia: Medicina, 84–105, 175–194.

Reis, F. M., Ribeiro-de-Oliveira, A. Jr., Machado, L., Guerra, R. M., Reis, A. M., Coimbra, C. C. (2008). Izmenenija prolaktina i gljukozy v plazme, inducirovannye hirurgicheskim stressom: edinaja ili dvojstvennaja reakcija? [Plasma prolactin and glucose alterations induced by surgical stress: a single or dual response?] Mini-review (Perevod i obrabotka V. Fesenko). Medicina neotlozhnyh sostojanij, 5 (18), 108–114.

Chumbley, G. M., Hall, G. M. (1997). Recovery after major surgery: does the anesthetic make any difference? British Journal of Anaesthesia, 78 (4), 347–349. doi: 10.1093/bja/78.4.347

Golub, I. E., Sorokina, L. V. (2005). Hirurgicheskij stress i obezbolivanie: monografija [Surgical stress and pain relief: a monograph]. 2-nd edition. Irkutsk, Russia, 201.

Taylor, L. K., Auchus, R. J., Baskin, L. S., Miller, W. L. (2013). Cortisol response to operative stress with anesthesia in healthy children. The Journal of Clinical Endocrinology & Metabolism, 98 (9), 3687–3693. doi: 10.1210/jc.2013-2148

Traynor, C., Hall, G. M. (1981). Endocrine and metabolic changes during surgery: anaesthetic implications. British Journal of Anaesthesia, 53 (2), 153–160. doi: 10.1093/bja/53.2.153

Baevskij, R. M., Ivanov, G. G., Chirejkin, L. V. (2001). Analiz variabel'nosti serdechnogo ritma pri ispol'zovanii razlichnyh jelektrokardiograficheskih sistem (metodicheskie rekomendacii) [Analysis of the heart rate variability using different electrocardiographic systems (guidelines)]. Vestnik aritmologii, 24, 66–85.

Haspekova, N. B. (2003). Diagnosticheskaja informativnost' monitorirovanija variabel'nosti ritma serdca [Diagnostic informativity during monitoring of the heart rate variability]. Vestnik aritmologii, 32, 15–27.

Olsson, E. (2010). Heart Rate Variability in Stress-related Fatigue, Adolescent Anxiety and Depression and its Connection to Lifestyle. Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Social Sciences. Acta Universtatis Upsaliensis, 66.

Makarov, L. M. (2003). Holterovskoe monitorirovanie [Holter monitoring]. 2-nd ed. Moscow, Russia: Medpraktika-M, 340.

Association of Paediatric Anaesthetists of Great Britain and Ireland. (2012). Good practice in postoperative and procedural pain management, 2nd edition. Paediatr Anaesth, 22, 1–79. doi: 10.1111/j.1460-9592.2012.03838.x

Tomlinson, D., von Baeyer, C. L., Stinson, J. N., Sung, L. A. (2010). A systematic review of faces scales for the self-report of pain intensity in children. Pediatrics, 126 (5), 1168–1198. doi: 10.1542/peds.2010-1609

Published

2015-03-19

Issue

Section

Medical