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Changes in autonomic nervous activity during endoscopic retrograde cholangiopancreatography: a possible factor in
Yoshie Ochi1, Masahiro Nomura, Seisuke Okamura
1Second Department of Internal Medicine, University of Tokushima, Japan.
Insights
Endoscopic retrograde cholangiopancreatography (ERCP) significantly alters autonomic nervous activity and hemodynamics, increasing cardiovascular risks. Monitoring these changes during ERCP is crucial for preventing complications.
Area of Science:
- Cardiology
- Gastroenterology
- Autonomic Neuroscience
Background:
- Autonomic nervous system (ANS) activity changes during ERCP are linked to cardiovascular complications.
- ERCP may influence heart rate variability and blood catecholamine levels.
Purpose of the Study:
- To evaluate the correlation between hemodynamic changes and autonomic nervous activity during ERCP.
- To assess cardiovascular system influence during ERCP.
Main Methods:
- Studied 23 ERCP patients and 15 controls, measuring ECG, blood pressure, oxygen saturation, and catecholamines.
- Assessed autonomic function using spectral analysis (LF power, HF power, LF/HF ratio) and 1/f fluctuation.
Main Results:
- ERCP group showed increased blood pressure, heart rate, and decreased oxygen saturation.
- Significant alterations in autonomic function parameters and increased catecholamines observed during ERCP, especially cholangiography.
Conclusions:
- ERCP significantly impacts autonomic nervous activity and the cardiovascular system.
- Monitoring hemodynamic parameters during ERCP is vital for managing patients with cardiovascular risks.
Background And Aims:
The changes of autonomic nervous activity during endoscopic retrograde cholangiopancreatography (ERCP) are closely related to the development of cardiovascular complications, such as arrhythmias and acute coronary syndrome. In the present study, the correlation between changes in hemodynamics and autonomic nervous activity during ERCP procedures was evaluated by analyzing heart rate variability and blood catecholamine levels.
Methods:
Twenty-three patients who underwent ERCP (ERCP group) and 15 control subjects who were only premedicated (C group) were studied. Ambulant ECG, blood pressure, arterial oxygen saturation, and blood level of catecholamine were measured. Autonomic nervous function was assessed by analyzing the spectral analysis and 1/f fluctuation. The low frequency power (LF power; 0.04-0.15 Hz), high frequency power (HF power; 0.15-0.40 Hz, indicator of parasymapathetic tone), the ratio of LF power to HF power (LF/HF ratio, indicator of sympathetic tone), and 1/f fluctuation (indicator of pleasant mood) were calculated.
Results:
Blood pressure and heart rate were increased and arterial oxygen saturation was decreased in the ERCP group during the endoscopic procedure. Changes in the parameters of autonomic nervous function (LF power, HF power, LF/HF ratio, and 1/f fluctuation) were significantly greater in the ERCP group than in the C group, especially during cholangiography. Moreover, blood levels of catecholamines were significantly increased during the ERCP procedure. In the C group, however, blood levels of catecholamines did not significantly change except directly after premedication.
Conclusions:
Autonomic nervous activity varied greatly during cholangiography, demonstrating that ERCP has more than a little influence on the cardiovascular system. The results of the present study indicated that attention should be focused on changes in hemodynamics in patients with cardiovascular complications by monitoring the aforementioned hemodynamic parameters during ERCP.