CHANGES OF VEGETATIVE HEART TONUS AFTER INDUCTION OF GENERAL ANESTHESIA WITH MIDAZOLAM AND FENTANYL
DOI:
https://doi.org/10.31379/2411.2616.12.2.2Keywords:
heart rate variability, sympathetic heart tonus, parasympathetic heart tonusAbstract
Background. Administration of midazolam and fentanyl for induction of general anesthesia is often associated with cardiovascular instability. This effect can be caused by changes in the cardiac vegetative tonus induced by the drugs. There are no studies which analyzed the changes in vegetative heart tonus during induction of general anesthesia with midazolam and fentanyl. The aim of the study was to establish the changes of vegetative heart tonus in induction of general anesthesia with fentanyl and midazolam. Materials and methods. There was performed a randomized prospective study which was approved by the Ethic Committee. Written informed consent was signed by all patients. The study group involved 47 patients scheduled for surgical intervention ASA I–II. The analysis of heart rate variability and the changes in cardiac vegetative tonus was performed with Holter ECG in baseline, after premedication with fentanyl solution and after induction of general anesthesia with midazolam and fentanyl. Results of the research. After administration of fentanyl in doses of 1.0 mkg/kg for premedication there were not significant changes of heart rate variability and vegetative heart tonus. Administration of midazolam 0.2–0.3 mg/kg combined with fentanyl 1.5 mkg/kg for induction of general anesthesia leads to significative changes of HRV. There was a significative reduction of heart rate variability. The LFun (marker of sympathetic heart tonus) reduced by 24.2% (69.1 (95% CI 65.9–72.3) vs 52.4 (95% CI 62.9–70.0) (p=0.14), meantime the HFun (marker of parasympathetic cardiac tonus) enhanced by 34.9% (30.9 (95% CI 27.6–34.1) vs 47.5 (95% CI 30.4– 57.4) (p=0.01). After administration of midazolam and fentanyl for induction of general anesthesia the LFun/HFun ratio was 1.1 (95% CI 0.6–1.8) (p=0.02), signaling the enhanced parasympathetic heart tonus. Conclusions. Administration of fentanyl solution in doses 1.0 mkg/kg for premedication is not associated with semnificative changes of vegetative tonus of the heart. Administration of midazolam 0.2–0.3 mg/kg in combination with fentanyl 1.5 mkg/kg for induction of general anesthesia leads to significant decrease of heart rate variability and enhanced parasympathetic cardiac tonus.
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