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KMID : 1155520170120020140
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Anesthesia and Pain Medicine
2017 Volume.12 No. 2 p.140 ~ p.146
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Heart rate variability may be more useful than pulse transit time for confirming successful caudal block under general anesthesia in children
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Song In-Kyung
Ji Sang-Hwan
Kim Eun-Hee
Lee Ji-Hyun
Kim Jin-Tae
Kim Hee-Soo
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Abstract
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Background: Confirming a successful caudal block is challenging in the pediatric population. Pulse transit time (PTT) may reflect the decrease in arterial resistance and may act as a potential indicator for confirming successful peripheral nerve or axial block. Heart rate variability (HRV) is also a possible candidate because it may be influenced by variation in sympathetic tone. We expected an increasing PTT pattern and change in HRV parameters after caudal block.
Methods: We enrolled 27 male patients (range, 1?4 years old) who were scheduled for urological surgeries. Caudal block was performed with 1 ml/kg of 0.25% ropivacaine and 1 : 200,000 epinephrine under sevoflurane anesthesia after the surgery. Successful block was confirmed by auscultation and ultrasonography. PTT and HRV parameters, such as standard deviation of normal-to-normal intervals, root mean square of successive differences, very low-frequency power, low-frequency power (LF), high-frequency power (HF), LF/HF ratio, approximate entropy (ApEn) were calculated based on electrocardiography from 1 min before to 5 min after the block. Those variables were analyzed by repeated measures analysis of variance.
Results: No significant change was found in PTT with time interval after caudal block. Heart rate and ApEn of the R-R interval decreased with time interval (P = 0.001, 0.033, respectively). Some HRV parameters showed notable changes, although statistically insignificant.
Conclusions: The PTT pattern may not be an indicator for successful caudal block. However, heart rate with parameters of HRV analysis may be alternatives.
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KEYWORD
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Caudal anesthesia, Heart rate
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