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Does the decrease in heart rate prevent a detrimental decrease of the end-systolic volume during central hypovolemia

K Sander-Jensen1, J Marving, N H Secher

  • 1Department of Medical Physiology C, Panum Institute, University of Copenhagen, Denmark.

Angiology
|September 1, 1990
PubMed
Summary
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Central hypovolemia during epidural anesthesia can cause a hypotensive bradycardic episode. This response appears to be triggered when left ventricular end-systolic volume decreases by approximately 25%, with heart rate slowing to prevent further reduction.

Area of Science:

  • Anesthesiology
  • Cardiovascular Physiology

Background:

  • Epidural anesthesia can induce central hypovolemia.
  • Hemodynamic and endocrine responses to hypovolemia vary among patients.

Purpose of the Study:

  • To investigate the hemodynamic and endocrine responses to central hypovolemia during epidural anesthesia.
  • To identify predictors of hypotensive bradycardic episodes.

Main Methods:

  • Measurement of hemodynamic and endocrine variables in 10 patients undergoing epidural anesthesia.
  • Utilized radionuclide cardiography to assess cardiac volumes.
  • Categorized patient responses into two groups based on observed effects.

Main Results:

  • Four patients experienced a hypotensive bradycardic episode, characterized by decreased end-diastolic, end-systolic, and stroke volumes, and reduced cardiac output.

Related Experiment Videos

  • This episode occurred after 17 ± 4 minutes, with heart rate decreasing to 49 ± 4 beats/min when left ventricular end-systolic volume decreased by ~25%.
  • The remaining six patients showed no significant hemodynamic or endocrine changes.

    • Conclusions:

    • A decrease in heart rate during epidural anesthesia-induced hypovolemia may be a protective mechanism triggered by a critical reduction in left ventricular end-systolic volume.
    • This heart rate slowing appears to prevent further decreases in ventricular volumes and cardiac output during progressive hypovolemia.