ABSTRACT
BACKGROUND: The autonomic nervous system is influenced by many stimuli including pain. Heart rate variability (HRV) is an indirect marker of the autonomic nervous system. Because of paucity of data, this study sought to determine the optimal thresholds of HRV above which the patients are in pain after minor spinal surgery (MSS). Secondly, we evaluated the correlation between HRV and the numeric rating scale (NRS). METHODS: Following institutional review board approval, patients who underwent MSS were assessed in the postanesthesia care unit after extubation. A laptop containing the HRV software was connected to the ECG monitor. The low-frequency band (LF: 0.04 to 0.5 Hz) denoted both sympathetic and parasympathetic activities, whereas the high-frequency band (HF: 0.15 to 0.4 Hz) represented parasympathetic activity. LF/HF was the sympathovagal balance. Pain was quantified by the NRS ranging from 0 (no pain) to 10 (worst imaginable pain). Simultaneously, HRV parameters were noted. Optimal thresholds were calculated using receiver operating characteristic curves with NRS>3 as cutoff. The correlation between HRV and NRS was assessed using the Spearman rank test. RESULTS: We included 120 patients (64 men and 56 women), mean age 51±14 years. The optimal pain threshold values were 298 ms for LF and 3.12 for LF/HF, with no significant change in HF. NRS was correlated with LF (r=0.29, P<0.005) and LF/HF (r=0.31, P<0.001) but not with HF (r=0.09, NS). CONCLUSIONS: This study suggests that, after MSS, values of LF>298 m and LF/HF>3.1 denote acute pain (NRS>3). These HRV parameters are significantly correlated with NRS.
Subject(s)
Acute Pain/physiopathology , Heart Rate/physiology , Pain Measurement/methods , Pain, Postoperative/physiopathology , Spine/surgery , Acute Pain/drug therapy , Adult , Anesthesia Recovery Period , Female , Humans , Male , Middle Aged , Pain Threshold , Pain, Postoperative/drug therapy , Prospective Studies , ROC Curve , Sympathetic Nervous System/physiopathology , Young AdultABSTRACT
Remodeling technique and stenting represent important options for intracranial aneurysm treatment, and they sometimes need to be combined. The technology of remodeling balloons and stents has recently evolved with the development of the double-lumen remodeling balloon (Scepter and Ascent) and the low-profile stent (LVIS Jr). This report describes our initial experience with and feasibility of the deployment of the low-profile stent through the balloon's internal guidewire lumen, thereby reducing the number of manoeuvres by combining remodeling and stenting.
