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Endoscopy 2004; 36(6): 508-514
DOI: 10.1055/s-2004-814402
Original Article
© Georg Thieme Verlag Stuttgart · New York

Sympathovagal Balance Fluctuates During Colonoscopy

M.  Petelenz1 , M.  Gonciarz1 , P.  Macfarlane2 , R.  Rudner3 , P.  Kawecki3 , J.  Musialik1 , P.  Jalowiecki3 , Z.  Gonciarz1
  • 1Department of Internal Medicine, Medical University of Silesia, Sosnowiec, Poland
  • 2Division of Cardiovascular and Medical Sciences, Section of Cardiology, University of Glasgow, Glasgow, Scotland, UK
  • 3Department of Anesthesiology, Intensive Therapy and Emergency Medicine, Medical University of Silesia, Sosnowiec, Poland
Further Information

Publication History

Submitted 28 April 2003

Accepted after Revision 21 January 2004

Publication Date:
17 June 2004 (online)

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Background and Study Aim: Colonoscopy is a common gastroenterological procedure for investigation of the bowel. The main side effects of colonoscopy are pain during investigation, cardiovascular complications and very rarely even death. The aim of this study was to compare the continuous fluctuation of heart rate variability (HRV) components during colonoscopy under normal conditions, analgesia/sedation, and total intravenous anesthesia. Patients and Methods: 37 consecutive patients (aged 35 - 65), were randomly allocated to three groups: no sedation (control group 1); analgesia/sedation (group 2); and total intravenous anesthesia (group 3). Holter electrocardiography and subsequent frequency domain analysis were undertaken. The low-frequency (LF, 0.04 - 0.15Hz) and the high-frequency (HF, 0.15 - 0.40Hz) components were estimated using spectral analysis in the usual way. Normalized units (nu) were calculated from the following equations: LFnu = LF/(LF + HF), and HFnu = HF/(LF + HF). Results: Groups 2 and 3 were found to have a significantly lower HFnu and higher LFnu than group 1 essentially throughout the procedure. A one-way analysis of variance and t-test confirmed that the differences were significant when the colonoscope reached the splenic flexure as were the LF/HF balances at the splenic and hepatic flexures and the cecum. The percentage change in LF/HF was also analyzed, and it was found that in group 3 the mean change was over 136 % when the colonoscope reached the sigmoid flexure, which was significantly higher than in the other two groups. Conclusion: Most changes in HRV components occurred during colonoscopy of the left side of the bowel. Analgesia/sedation and total intravenous anesthesia increased HRV by increasing the LF component.

References

  • 1 Nelson D B, McQuaid K R, Bond J H. et al . Procedural success and complications of large-scale screening colonoscopy.  Gastrointest Endosc. 2002;  55 307-314
    CrossrefPubMedSearch in Google Scholar
  • 2 Wexner S D, Garbus J E, Singh J J. The SAGES Colonoscopy Study Outcomes Group. A prospective analysis of 13 580 colonoscopies. Reevaluation of credentialing guidelines.  Surg Endosc. 2001;  15 251-261
    CrossrefPubMedSearch in Google Scholar
  • 3 Puchner R, Allinger S, Doblhofer F, Wallner M. et al . Complications of diagnostic and interventional colonoscopy.  Wien Klin Wochenschr. 1996;  108 142-145
    PubMedSearch in Google Scholar
  • 4 Arrowsmith J B, Gertsman B, Fleischer D E. Results from American Society for Gastrointestinal Endoscopy/U.S. Food and Drug Administration collaborative study on complication rates and drug use during gastrointestinal endoscopy.  Gastrointest Endosc. 1991;  86 421-427
    PubMedSearch in Google Scholar
  • 5 DiSario J A, Waring J P, Talbert G, Sanowski R A. Monitoring of blood pressure and heart rate during routine endoscopy: a prospective, randomized, controlled study.  Am J Gastroenterol. 1991;  86 956-960
    PubMedSearch in Google Scholar
  • 6 Holm C, Christensen M, Schulze S, Rosenberg J. Effect of oxygen on tachycardia and arterial oxygen saturation during colonoscopy.  Eur J Surg. 1999;  165 755-758
    CrossrefPubMedSearch in Google Scholar
  • 7 Holm C, Christensen M, Rasmussen V. et al . Hypoxaemia and myocardial ischaemia during colonoscopy.  Scand J Gastroenterol. 1998;  33 769-772
    CrossrefPubMedSearch in Google Scholar
  • 8 Herman L, Kurtz R, McKee K. et al . Risk factors associated with vasovagal reactions during colonoscopy.  Gastrointest Endosc. 1993;  39 388-391
    PubMedSearch in Google Scholar
  • 9 Bigger J, Fleiss J, Steinman R. et al . RR variability in healthy, middle-aged persons compared with patients with chronic coronary disease or recent acute myocardial infaction.  Circulation. 1995;  91 1936-1943
    PubMedSearch in Google Scholar
  • 10 Lombardi F, Sandrome G, Mortara A. et al . Heart rate variability as an index of sympatho-vagal interaction after myocardial infarction.  Am J Cardiol. 1987;  60 1239-1245
    CrossrefPubMedSearch in Google Scholar
  • 11 Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology . Heart rate variability: standards of measurement, physiological interpretation, and clinical use.  Circulation. 1996;  93 1043-1065
    Search in Google Scholar
  • 12 Kamath M, Djuric V, Tougas G. et al . Heart rate variability in gastroenterological diagnosis.  Proc IEEE Comput Cardiol. 1995;  289-291
    PubMedSearch in Google Scholar
  • 13 Petelenz M, Musialik J, Besser P. et al . Cardiac sympathethic balance during endoscopic retrograde cholangiopancreatography.  Endoscopy. 2000;  32 683-687
    Thieme ConnectPubMedSearch in Google Scholar
  • 14 Ristikankare M, Julkunen R, Laitinen T. et al . Effect of conscious sedation on cardiac autonomic regulation during colonoscopy.  Scand J Gastroenterol. 2000;  35 990-996
    CrossrefPubMedSearch in Google Scholar
  • 15 Ramsay M AE, Savege T M, Simpson B RJ, Goodwin R. Controlled sedation with alphaxalone-alphadolone.  BMJ. 1974;  ii 656-659
    PubMedSearch in Google Scholar
  • 16 Flaishon R, Windsor A, Sigl J, Sebel P S. Recovery of consciousness after thiopental or propofol: bispectral index and the isolated forearm technique.  Anesthesiology. 1997;  86 613-619
    PubMedSearch in Google Scholar
  • 17 Glass P S, Bloom M, Kearse L. et al . Bispectral analysis measures sedation and memory effects of propofol, midazolam, isofluran and alfentanil in healthy volunteers.  Anesthesiology. 1997;  86 836-847
    CrossrefPubMedSearch in Google Scholar
  • 18 Notini-Gudmarsson A K, Dolk A, Jakobsson J, Johansson C. Nitrous oxide: a valuable alternative for pain relief and sedation during routine colonoscopy.  Endoscopy. 1996;  28 283-287
    Thieme ConnectPubMedSearch in Google Scholar
  • 19 Eckardt V F, Kanzler G, Schmitt T. et al . Complications and adverse effects of colonoscopy with selective sedation.  Gastrointest Endosc. 1999;  49 560-565
    PubMedSearch in Google Scholar
  • 20 Vargo J. Sedation and analgesia in 2002: gastroenterologist, anesthesiologist, or both? Scientific Session Handouts. Digestive Diseases Week -; 2002. May 19 - 22 San Francisco, California. 2002: 87-93
    Search in Google Scholar
  • 21 Lazzaroni M, Bianchi Porro G. Preparation, premedication and surveillance.  Endoscopy. 2003;  35 103-111
    Thieme ConnectPubMedSearch in Google Scholar
  • 22 Williams P, Warwick R, Dyson M, Bannister L (eds). Gray’s anatomy. 37th edn. Edinburgh; Churchill Livingstone 1989: 1164-1169
    Search in Google Scholar
  • 23 Williams P, Warwick R, Dyson M, Bannister L (eds). Gray’s anatomy. 37th edn. Edinburgh; Churchill Livingstone 1989: 1374-1375
    Search in Google Scholar
  • 24 Practice guidelines for sedation and analgesia by non-anesthesiologists. An update report by the American Society of Anaesthesiologists’ Task Force on the sedation and analgesia by non-anesthesiologists.  Anesthesiology. 2002;  96 1004-1017
    CrossrefPubMedSearch in Google Scholar
  • 25 Winstanley P. Medical pharmacology. Edinburgh; Churchill Livingstone 2002
    Search in Google Scholar
  • 26 Ristikankare M, Julkunen R, Mattila M. et al . Conscious sedation and cardiorespiratory safety during colonoscopy.  Gastrointest Endosc. 2000;  52 48-54
    CrossrefPubMedSearch in Google Scholar
  • 27 Komatsu T, Singh P, Kimura T. et al . Differential effects of ketamine and midazolam on heart rate variability.  Can J Anaesth. 1995;  42 1003-1009
    PubMedSearch in Google Scholar
  • 28 Podrid P, Fuchs T, Candinas R. Role of the sympathetic nervous system in the genesis of ventricular arrhythmia.  Circulation. 1990;  82 Suppl 1 103-113
    PubMedSearch in Google Scholar
  • 29 Malliani A, Pagani M, Lombardi F. Physiology and clinical implications of variability of cardiovascular parameters with focus on heart rate and blood pressure.  Am J Cardiol. 1994;  73 3-9
    PubMedSearch in Google Scholar

M. Petelenz

Department of Internal Medicine, Medical University of Silesia

Pl. Medykow 1 · 41-200 Sosnowiec · Poland

Fax: +48-32-3682023

Email: mpet@sla.com.pl