Differences of Heart Rate Variability during Sevoflurane Anesthesia in Children by Age

Yong-Hee Park, Chang-Hoon Koo, Jin-Tae Kim, Hee-Soo Kim, Hyo-Jin Byon

College of Medicine, Seoul National University, Seoul, Korea.
Department of Anesthesiology and Pain Medicine.
Department of Anesthesiology and Pain Medicine, College of Medicine, Inha University, Incheon, Korea.
Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, Korea.

DOI: 10.4236/ojanes.2012.23018                

Abstract

Background: The child’s central nervous system develops with aging, and heart rate variability (HRV), which is con-trolled by the brain, differs from that of adults. We investigated changes in HRV during sevoflurane anesthesia in children. Methods: One 138 children aged from 2 - 12 years without major underlying problems were enrolled. During maintenance with 2 - 2.5 vol% sevoflurane anesthesia, electrocardiographic data were obtained and power spectral analysis, approximate entropy (ApEn) or Hurst exponent were analyzed and compared in three groups (age 2 - 5 years, 6 - 9 and 10 - 12 years of age). Results: The RR interval increased with aging, but low-frequency powers did not. High- frequency power was greater in the oldest children (P < 0.05), while ApEn and Hurst exponents were lower (P < 0.05). Conclusion: Change in HRV is one of the characteristics of development in children.

Keywords

Children; Heart Rate Variability; Sevoflurane

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	J. P. Saul, R. F. Rea, D. L. Eckberg, R. D. Berger and R. J. Cohen, “Heart Rate and Muscle Sympathetic Nerve Variability during Reflex Changes of Autonomic Activity,” American Journal of Physiology, Vol. 258, No. 3, 1990, pp. H713-H721.
[2]	C. Liu, P. Shao, L. Li, X. Sun, X. Wang and F. Liu, “Comparison of Different Threshold Values r for Approximate Entropy: Application to Investigate the Heart Rate Variability between Heart Failure and Healthy Control Groups,” Physiological Measurement, Vol. 32, No. 2, 2011, pp. 167-180. doi:10.1088/0967-3334/32/2/002
[3]	N. Haddad, R. B. Govindan, S. Vairavan, E. Siegel, J. Temple, H. Preissl, C. L. Lowery and H. Eswaran, “Correlation between Fetal Brain Activity Patterns and Behavioral States: An Exploratory Fetal Magnetoencephalography Study,” Experimental Neurology, Vol. 228, No. 2, 2011, pp. 200-205. doi:10.1016/j.expneurol.2011.01.003
[4]	A. C. Takahashi, A. Porta, R. C. Melo, R. J. Quiterio, E. Da Silva, A. Borghi-Silva, E. Tobaldini, N. Montano and A. M. Catai, “Aging Reduces Complexity of Heart Rate Variability Assessed by Conditional Entropy and Symbolic Analysis,” Internal and Emergency Medicine, Vol. 7, No. 3, 2012, pp. 229-235. doi:10.1007/s11739-011-0512-z
[5]	D. L. Toweill, W. D. Kovarik, R. Carr, D. Kaplan, S. Lai, S. Bratton and B. Goldstein, “Linear and Nonlinear Analysis of Heart Rate Variability during Propofol Anesthesia for Short-Duration Procedures in Children,” Pediatric Critical Care Medicine, Vol. 4, No. 3, 2003, pp. 308-314. doi:10.1097/01.PCC.0000074260.93430.6A
[6]	E. Wodey, L. Senhadji, P. Pladys, F. Carre and C. Ecoffey, “The Relationship between Expired Concentration of Sevoflurane and Sympathovagal Tone in Children,” Anesthesia & Analgesia, Vol. 97, No. 2, 2003, pp. 377-382. doi:10.1213/01.ANE.0000068825.96424.F3
[7]	Y. C. Arai, M. Nakayama, N. Kato, Y. Wakao, H. Ito and T. Komatsu, “The Effects of Jaw Thrust and the Lateral Position on Heart Rate Variability in Anesthetized Children with Obstructive Sleep Apnea Syndrome,” Anesthesia & Analgesia, Vol. 104, No. 6, 2007, pp. 1352-1355. doi:10.1213/01.ane.0000262041.46833.21
[8]	A. Cooke, M. Kavussanu, D. Mcintyre and C. Ring, “Effects of Competition on Endurance Performance and the Underlying Psychological and Physiological Mechanisms,” Biological Psychology, Vol. 86, No. 3, 2011, pp. 370-378. doi:10.1016/j.biopsycho.2011.01.009
[9]	M. Mizuno, T. Kawada, A. Kamiya, T. Miyamoto, S. Shimizu, T. Shishido, S. A. Smith and M. Sugimachi, “Exercise Training Augments the Dynamic Heart Rate Response to Vagal but Not Sympathetic Stimulation in Rats,” American Journal of Physiology—Regulatory, Integrative and Comparative Physiology, Vol. 300, No. 4, 2011, pp. R969-R977. doi:10.1152/ajpregu.00768.2010
[10]	J. Hu, J. Gao, W. W. Tung and Y. Cao, “Multiscale Analysis of Heart Rate Variability: A Comparison of Different Complexity Measures,” Annals of Biomedical Engineering, Vol. 38, No. 3, 2010, pp. 854-864. doi:10.1007/s10439-009-9863-2
[11]	C. Jeleazcov, J. Schmidt, B. Schmitz, K. Becke and S. Albrecht, “EEG Variables as Measures of Arousal during Propofol Anaesthesia for General Surgery in Children: Rational Selection and Age Dependence,” British Journal of Anaesthesia, Vol. 99, No. 6, 2007, pp. 845-854. doi:10.1093/bja/aem275
[12]	H. Nazeran, R. Krishnam, S. Chatlapalli, Y. Pamula, E. Haltiwanger and S. Cabrera, “Nonlinear Dynamics Analysis of Heart Rate Variability Signals to Detect Sleep Disordered Breathing in Children,” 28th Annual International Conference of the IEEE Engineering in Medicine and Biology Society, New York, 30 August-3 September 2006, pp. 3873-3878. doi:10.1109/IEMBS.2006.260709
[13]	V. Papaioannou, M. Giannakou, N. Maglaveras, E. Sofianos and M. Giala, “Investigation of Heart Rate and Blood Pressure Variability, Baroreflex Sensitivity, and Approximate Entropy in Acute Brain Injury Patients,” Journal of Critical Care, Vol. 23, No. 3, 2008, pp. 380-386. doi:10.1016/j.jcrc.2007.04.006
[14]	U. R. Acharya, N. Kannathal, O. W. Sing, L. Y. Ping and T. Chua, “Heart Rate Analysis in Normal Subjects of Various Age Groups,” BioMedical Engineering OnLine, Vol. 3, No. 1, 2004, p. 24. doi:10.1186/1475-925X-3-24
[15]	M. Maenpaa, T. Laitio, T. Kuusela, J. Penttila, K. Kaisti, S. Aalto, S. Hinkka-Yli-Salomaki and H. Scheinin, “Delta Entropy of Heart Rate Variability along with Deepening Anesthesia,” Anesthesia & Analgesia, Vol. 112, No. 3, 2011, pp. 587-592. doi:10.1213/ANE.0b013e318208074d
[16]	J. Pan and W. J. Tompkins, “A Real-Time QRS Detection Algorithm,” IEEE Transactions on Biomedical Engineering, Vol. 32, No. 3, 1985, pp. 230-236. doi:10.1109/TBME.1985.325532
[17]	S. Akselrod, D. Gordon, F. A. Ubel, D. C. Shannon, A. C. Berger and R. J. Cohen, “Power Spectrum Analysis of Heart Rate Fluctuation: A Quantitative Probe of Beat-toBeat Cardiovascular Control,” Science, Vol. 213, No. 4504, 1981, pp. 220-222. doi:10.1126/science.6166045
[18]	A. Fujiki, A. Masuda and H. Inoue, “Effects of Unilateral Stellate Ganglion Block on the Spectral Characteristics of Heart Rate Variability,” Japanese Circulation Journal, Vol. 63, No. 11, 1999, pp. 854-858. doi:10.1253/jcj.63.854
[19]	R. Furlan, S. Piazza, S. Dell’orto, F. Barbic, A. Bianchi, L. Mainardi, S. Cerutti, M. Pagani and A. Malliani, “Cardiac Autonomic Patterns Preceding Occasional Vasovagal Reactions in Healthy Humans,” Circulation, Vol. 98, No. 17, 1998, pp. 1756-1761. doi:10.1161/01.CIR.98.17.1756
[20]	S. M. Pincus, T. R. Cummins and G. G. Haddad, “Heart Rate Control in Normal and Aborted-SIDS Infants,” Am J Physiol, Vol. 264, No. 3, 1993, pp. R638-R346.
[21]	S. M. Pikkujamsa, T. H. Makikallio, L. B. Sourander, I. J. Raiha, P. Puukka, J. Skytta, C. K. Peng, A. L. Goldberger and H. V. Huikuri, “Cardiac Interbeat Interval Dynamics from Childhood to Senescence: Comparison of Conventional and New Measures Based on Fractals and Chaos Theory,” Circulation, Vol. 100, No. 4, 1999, pp. 393-399. doi:10.1161/01.CIR.100.4.393
[22]	M. K. Yum and J. H. Kim, “A Very-Short-Term Intermittency of Fetal Heart Rates and Developmental Milestone,” Pediatric Research, Vol. 53, No. 6, 2003, pp. 915919. doi:10.1203/01.PDR.0000064945.53546.8E
[23]	M. K. Yum, J. T. Kim and H. S. Kim, “Increased NonStationarity of Heart Rate during General Anaesthesia with Sevoflurane or Desflurane in Children,” British Journal of Anaesthesia, Vol. 100, No. 6, 2008, pp. 772-779. doi:10.1093/bja/aen080
[24]	J. P. Finley, S. T. Nugent and W. Hellenbrand, “HeartRate Variability in Children. Spectral Analysis of Developmental Changes between 5 and 24 Years,” Canadian Journal of Physiology and Pharmacology, Vol. 65, No. 10, 1987, pp. 2048-2052. doi:10.1139/y87-320
[25]	B. Krishnan, A. Jeffery, B. Metcalf, J. Hosking, L. Voss, T. Wilkin and D. E. Flanagan, “Gender Differences in the Relationship between Heart Rate Control and Adiposity in Young Children: A Cross-Sectional Study (EarlyBird 33),” Pediatric Diabetes, Vol. 10, No. 2, 2009, pp. 127134. doi:10.1111/j.1399-5448.2008.00455.x
[26]	M. P?yh?nen, S. Syv?oja, J. Hartikainen, E. Ruokonen and J. Takala, “The Effect of Carbon Dioxide, Respiratory Rate and Tidal Volume on Human Heart Rate Variability,” Acta Anaesthesiologica Scandinavica, Vol. 48, No. 1, 2004, pp. 93-101. doi:10.1111/j.1399-6576.2004.00272.x
[27]	A. Jovic and N. Bogunovic, “Electrocardiogram Analysis Using a Combination of Statistical, Geometric, and Nonlinear Heart Rate Variability Features,” Artificial Intelligence in Medicine, Vol. 51, No. 3, 2011, pp. 175-186. doi:10.1016/j.artmed.2010.09.005
[28]	P. Abry, H. Wendt, S. Jaffard, H. Helgason, P. Goncalves, E. Pereira, C. Gharib, P. Gaucherand and M. Doret, “Methodology for Multifractal Analysis of Heart Rate Variability: From LF/HF Ratio to Wavelet Leaders,” Annual International Conference of the IEEE Engineering in Medicine and Biology Society, Buenos Aires, 31 August-September 4 2010, pp. 106-109. doi:10.1109/IEMBS.2010.5626124
[29]	Y. Fukuba, H. Sato, T. Sakiyama, M. Yamaoka Endo, M. Yamada, H. Ueoka, A. Miura and S. Koga, “Autonomic Nervous Activities Assessed by Heart Rate Variability in Preand Post-Adolescent Japanese,” Journal of Physiological Anthropology, Vol. 28, No. 6, 2009, pp. 269-273. doi:10.2114/jpa2.28.269