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Prolonged decrease in heart rate variability after elective hip arthroplasty

S C Marsch1, K Skarvan, H G Schaefer

  • 1Department of Anaesthesia, Kantonsspital, Basel, Switzerland.

British Journal of Anaesthesia
|June 1, 1994
PubMed
Summary
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Postoperative heart rate variability significantly decreases after hip arthroplasty, indicating prolonged autonomic nervous system suppression. This reduction in heart rate variability affects both parasympathetic and sympathetic influences for up to five days.

Area of Science:

  • Anesthesiology and Perioperative Medicine
  • Cardiovascular Physiology
  • Autonomic Neuroscience

Background:

  • Heart rate variability (HRV) reflects autonomic nervous system (ANS) function.
  • Postoperative changes in HRV can indicate the ANS's response to anesthesia and surgery.

Purpose of the Study:

  • To investigate the pattern of HRV following hip arthroplasty.
  • To assess the impact of anesthesia and surgery on autonomic function.

Main Methods:

  • Continuous perioperative Holter monitoring was used in 15 patients undergoing elective hip arthroplasty.
  • Spectral and non-spectral HRV indices were analyzed from electrocardiographic recordings.
  • Patients received either spinal or general anesthesia with an uncomplicated postoperative course.

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Main Results:

  • Total, low-frequency, and high-frequency spectral energy of HRV decreased significantly post-surgery (to 32%, 29%, and 33% of preoperative values, respectively).
  • These HRV indices remained suppressed for up to 5 days postoperatively.
  • Non-spectral HRV indices showed a similar prolonged decrease.

Conclusions:

  • Surgery and anesthesia cause a substantial and prolonged reduction in HRV after hip arthroplasty.
  • Both parasympathetic and sympathetic influences on the sinus node are significantly diminished in the early postoperative period.
  • HRV monitoring may be a valuable tool for assessing long-term autonomic recovery.