CHANGES OF ARTERIAL BLOOD PRESSURE AND HEART RATE DURING INDUCTION OF ANESTHESIA WITH MIDAZOLAM AND FENTANYL. IS ENHANCED BASAL CARDIAC PARASYMPATHETIC TONUS A RISK FACTOR FOR CARDIOVASCULAR INSTABILITY?
DOI:
https://doi.org/10.31379/2411.2616.13.1.3Keywords:
arterial hypotension, sinus bradycardia, cardiac parasympathetic tonusAbstract
Background. Induction of general anesthesia with midazolam and fentanyl is frequently associated with changes in arterial blood pressure and heart rate. At present, there are no clinical studies investigating the relation between basal cardiac autonomic tonus and cardiovascular instability after induction of general anesthesia with midazolam and fentanyl. The aim of the study was to evaluate the changes of arterial blood pressure and heart rate after induction of general anesthesia with midazolam and fentanyl and to determine if a relationship exists between basal cardiac autonomic tonus and hemodynamic instability. Materials and methods. A randomized prospective study was performed with approval of Ethic Committee. Written informed consent was obtained from all patients. We enrolled in the study 47 ASA physical status I–II patients scheduled for elective surgical procedures. Heart rate variability by Holter ECG, arterial blood pressure (systolic, diastolic, mean), and heart rate were measured at baseline, after premedication, as well as after induction of general anesthesia with midazolam 0.2- 0.3 mg/kg and fentanyl 1.5 mkg/kg Results of the research. Induction of general anesthesia with midazolam and fentanyl was associated with an increase in cardiac parasympathetic tonus. Our research revealed that increased basal cardiac parasympathetic tonus was a risk factor for development of sinus bradycardia (OR = 13.1 (95%CI 3.1-54.7, p=0.0002) and arterial hypotension (OR = 12.7 (95%CI 2.9 -55.9, p=0.0003). Conclusions. Induction of general anesthesia with midazolam and fentanyl was associated with arterial hypotension and sinus bradycardia. Increased basal cardiac parasympathetic tonus represents a risk factor for development of arterial hypotension and sinus bradycardia after administration of midazolam and fentanyl for induction of general anesthesia.
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