Power Spectral Analysis of Heart Rate Variability during Total Spinal Anesthesia in Rats / 대한마취과학회지

BACKGROUND: Total spinal anesthesia (TSA) anesthetizes cranial nerves as well as peripherial nerves, leading to specific circulatory perturbations related to autonomic imbalance between sympathetic and parasympathetic tone. Heart rate variability (HRV) result from moment-to-moment changes in sympathetic and parasympathetic activity in response to many conditions. Using a power spectral analysis of heart rate variability, we evaluated the effect of TSA on the changes in the autonomic nervous system. METHODS: Twenty-four Sprague-Dawley rats, during halothane anesthesia, were placed in a stereotaxic head holder. Polyethylene tubing (PE-10) was passed caudally from the cisterna magna, and these rats were anesthetized by a urethane intraperitoneal injection (1.5 g/kg). Succinylcholine was infused intravenously at 1 mg/kg/min. During mechanical ventilation, ECG signals and mean arterial blood pressure were recorded for 5 min after a period of 10 min of anesthetic stabilization (baseline). Lidocaine (40 mg/kg) was administered intrathecally and then two subsequent 5-min ECG signals and mean arterial blood pressure were recorded (TSA 0 5 min, 5 10 min). A power spectral analysis of the data was computed using a short-time Fourier transform. The spectral peaks within each measurement were calculated; low frequency area (0.25 0.75 Hz), high frequency area (0.75 3.0 Hz), total frequency area (0.25 3.0 Hz). RESULTS: Mean R-R interval increases progressively during the 5 minutes after TSA but mean blood pressure decreases to the level of blood pressure of TSA within 2 minutes after TSA (p < 0.05). TSA diminished HRV within 2 minutes after a spinal injection of lidocaine (p < 0.05). CONCLUSIONS: These results suggest that total spinal anesthesia depresses both sympathetic and parasympathetic tone within 2 minutes.

Anesthetic Management of Carotid Endarterectomy under Cervical Plexus Block / 대한마취과학회지

BACKGROUND: The purpose of this study was to determine the possibility and safety of performing carotid endarterectomy under cervical plexus block. METHODS: Carotid endarterectomy was performed in 30 cases with deep and superficial cervical plexus block, to monitor the patient for cerebral ischemia in the awake state. The toy horn was placed in the contralateral hand in each case and was activated by the patient on command and patients had counted ten repeatedly during carotid clamping. Patients who had not been experienced in the change of mental status or motor response had been operated without a shunt. RESULTS: Cerebral ischemia requiring shunt was observed in one case (3.3%). There were no permanent neurologic deficit and major cardiovascular complication and mortality. CONCLUSIONS: Carotid endarterectomy under cervical plexus block allows direct and precise observation of the patient's central nervous system function during the operation.