Assessment of Baroreflex Control of Heart Rate During General Anesthesia Using a Point Process Method

Evaluation of baroreflex control of heart rate (HR) has important implications in clinical practice of anesthesia and postoperative care. In this paper, we present a point process method to assess the dynamic baroreflex gain using a closed-loop model of the cardiovascular system. Specifically, the inverse Gaussian probability distribution is used to model the heartbeat interval, whereas the instantaneous mean is identified by a linear or bilinear bivariate regression on the previous R-R intervals and blood pressure (BP) measures. The instantaneous baroreflex gain is estimated in the feedback loop with a point process filter, while the RR→BP feedforward frequency response is estimated by a Kalman filter. In addition, the instantaneous cross-spectrum and cross-bispectrum (as well as their ratio) can also be estimated. All statistical indices provide a valuable quantitative assessment of the interaction between heartbeat dynamics and hemodynamics during general anesthesia.