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Clinical assessment of propofol-induced yawning with heart rate variability: a pilot study
Chih-Hsiang Tsou1, Tsair Kao, Kuo-Tung Fan
1Department of Pulmonology, Ren-Ai Branch, Taipei City Hospital, Taipei 483, Taiwan.
Study Objectives:
To investigate the proportion of propofol-induced yawning and sympathovagal balance during propofol-induced yawning.
Design:
Prospective, observational, clinical study.
Setting:
University hospital and 2400-bed tertiary medical center.
Patients:
546 ASA physical status I and II patients undergoing elective surgery with general anesthesia.
Interventions:
Standard induction of anesthesia was performed with intravenous (IV) propofol two to four mg/kg (group P), or pretreatment with atropine 0.1 mg/kg (group AP) or with fentanyl 1 to 3 microg/kg (group FP) before propofol. Continuous standard electrocardiogram for heart rate variability (HRV) was performed in another 20 patients to investigate sympathovagal balance during propofol-induced yawning.
Measurements And Main Results:
The proportions of yawning were 53.5% (207/386), 61.1% (55/90), and 0% (0/50) in the P, AP, and FP groups, respectively. Propofol-induced yawning could be dramatically decreased by pretreatment with IV fentanyl (P < 0.001, chi2 test). Significant increased ratio of low-frequency/high-frequency power was detected during HRV monitoring in 9 patients with yawning in comparison with 11 patients without yawning (P < 0.05, Wilcoxon signed-rank test).
Conclusions:
Pretreatment with fentanyl may inhibit propofol-induced yawning. Fluctuations in autonomic function have been noted during propofol-induced yawning.
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