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Updated: Aug 20, 2026
Measuring Cardiac Autonomic Nervous System (ANS) Activity in Children
Published on: April 29, 2013
Pilot study of preoperative heart rate variability and adverse events in children emerging from anesthesia
Tom Elwood1, Frank Cecchin, Jasmine I Low
1Department of Anesthesiology, Children's Hospital and Regional Medical Center, Seattle, WA, USA.
Insights
Preoperative heart rate variability (HRV) measurements may help predict adverse respiratory events during anesthesia emergence in children. Brief HRV tests showed promise, but are insufficient as a standalone screening tool.
Area of Science:
- Pediatric Anesthesiology
- Autonomic Nervous System Function
- Respiratory Physiology
Background:
- Autonomic cardiac activity, measured by heart rate variability (HRV), plays a role in physiological regulation.
- Adverse respiratory events during anesthesia emergence in children are a significant concern.
Purpose of the Study:
- To investigate the correlation between preoperative heart rate variability and adverse respiratory events in pediatric patients during anesthesia emergence.
- To evaluate the predictive value of different HRV measurement durations for these events.
Main Methods:
- A case-control study involving 61 children (8 months to 13 years) undergoing anesthesia.
- Preoperative heart rate variability was assessed using brief (5-min) electrocardiography with orthostatic challenge and 24-hour Holter monitoring.
- Adverse respiratory events (coughing, laryngospasm, desaturation) during emergence were recorded.
Main Results:
- A significant difference in the orthostatic change of HRV (low-frequency/high-frequency ratio) was observed between children with and without adverse emergence events (p = .019).
- Brief preoperative HRV recordings demonstrated 85% sensitivity and 52% specificity in predicting adverse events.
- 24-hour Holter-derived HRV showed no correlation with adverse emergence events.
Conclusions:
- Brief preoperative heart rate variability measurements show potential for predicting adverse respiratory events during anesthesia emergence in children.
- The current predictive capability is insufficient for use as a routine preoperative screening test.
- Further research may explore the utility of HRV in understanding pediatric perioperative pathophysiology.
Objective:
To assess correlations between preoperative heart rate variability (a noninvasive measure of autonomic cardiac activity) and adverse respiratory events during anesthesia emergence in children.
Design:
Case control study.
Setting:
Tertiary care pediatric operating room.
Patients:
Sixty-one children, aged 8 months to 13 yrs.
Interventions:
None.
Measurements And Main Results:
Heart rate power spectra were obtained from two 5-min immediate-preoperative electrocardiographs with an orthostatic posture change interposed and (n = 32) from a 24-hr preoperative Holter monitor. Observers recorded emergence from standardized anesthesia for coughing, laryngospasm, and desaturation. Low-frequency/high-frequency ratios (LF/HF) were derived from power spectra of heart rate variability. The orthostatic change in heart rate variability derived from brief preoperative recordings was significantly different if adverse events occurred during emergence from anesthesia (LF/HF standing/LF/HF supine = 1.3 vs. 2.8, p = .019). Holter-derived heart rate variability had no correlation with adverse events. Receiver operating characteristic analysis showed a sensitivity of 85% and specificity of 52% for predicting adverse events with preoperative recordings.
Conclusions:
This study provides new information regarding pathophysiology in children with upper respiratory infection. The magnitude of difference demonstrated is insufficient to propose this method as a preoperative screening test.