Evaluation der Herzratenvariabilität als Narkosetiefenmonitoring beim Hund

C. Bergfeld; M. Beyerbach; A. M. Voigt; S. B. R. Kästner

doi:10.15654/TPK-130744

Tierärztliche Praxis Ausgabe K: Kleintiere / Heimtiere, Table of Contents

Tierarztl Prax Ausg K Kleintiere Heimtiere 2015; 43(01): 5-14
DOI: 10.15654/TPK-130744

Originalartikel

Schattauer GmbH

Evaluation der Herzratenvariabilität als Narkosetiefenmonitoring beim Hund

Untersuchung anhand total intravenöser Propofolanästhesie allein sowie in Kombination mit Dexmedetomidin oder RemifentanilEvaluation of heart rate variability for monitoring the depth of anaesthesia in dogsInvestigations based on total intravenous anaesthesia using propofol alone or in combination with dexmedetomidine or remifentanil

C. Bergfeld

¹Klinik für Kleintiere, Tierärztliche Hochschule Hannover

,

M. Beyerbach

²Institut für Biometrie Epidemiologie und Informationsverarbeitung, TiHo Hannover

,

A. M. Voigt

³Kleintierklinik Hannover

,

S. B. R. Kästner

¹Klinik für Kleintiere, Tierärztliche Hochschule Hannover

› Author Affiliations

Abstract

Zusammenfassung

Zielstellung: Evaluation der Herzratenvariabilität (HRV) als Indikator für autonome Aktivität für das Narkosetiefenmonitoring beim Hund während drei verschiedenen total intravenösen Anästhesieprotokollen, drei Narkosetiefen sowie vor und nach elektrischer nozizeptiver Stimulation. Material und Methoden: Die der randomisierten, experimentellen Studie mit komplettem Cross-over-Design zugrunde liegenden Daten wurden an sieben Beaglen (14,3 ± 1,7 kg) erhoben. Jeder Hund durchlief drei Anästhesieprotokolle: Propofol allein (Gruppe P) sowie Propofol in Kombination mit Dexmedetomidin (3 µg/kg/h, Gruppe PD) oder Remifentanil (18 µg/kg/h, Gruppe PR). Propofol wurde als “Target Controlled Infusion” (TCI) verabreicht. Drei Narkosetiefen (flach, mittel, tief) wurden über Propofol-Zielkonzentrationen im Blut definiert und tierindividuell angepasst (durchschnittlich 7, 9 und 11 µg/ml in Gruppe P bzw. 3, 5 und 7 µg/ml in Gruppe PD und PR). Während jeder Narkosetiefe wurde ein standardisierter nozizeptiver Reiz in Form supramaximaler elektrischer Stimulation (50 Hz, 50 V, 10 ms) medial am rechten Unterarm gesetzt. Das Elektrokardiogramm (EKG) wurde kontinuierlich bipolar abgeleitet und aufgezeichnet. In die statistische Auswertung gingen für jede Narkosetiefe die aus den EKG-Daten ermittelten RRIntervalle genau 2 Minuten vor und nach jeder Reizgabe ein. Mittels eines Analyseprogramms (Kubios HRV) für die HRV wurden neben den frequenzabhängigen HRV-Parametern Low Frequency (LF) und High Frequency (HF) die zeitabhängigen HRV-Parameter Standardabweichung des Mittelwerts der RR-Intervalle (SDNN) und die Quadratwurzel des Mittelwerts der Summe der quadrierten Differenzen zwischen aufeinander folgenden RR-Intervallen (RMSSD) ermittelt. Ergebnisse: Weder die RR-Intervalle noch die aus den RR-Intervallen abgeleiteten HRV-Parameter ermöglichten eine Differenzierung zwischen den über die Propofol-Zielkonzentrationen definierten Narkosetiefen, was gegen ihre Verwendbarkeit als klinisches Narkosetiefenmonitoring spricht. Nozizeption ließ sich allein durch die RR-Intervalle abbilden. Schlussfolgerung: Insgesamt zeigten sich die untersuchten HRVParameter für die Narkosetiefenbestimmung als wenig gewinnbringend.

Summary

Objective: Evaluation of heart-rate variability (HRV) as an indicator for autonomous activity to monitor anaesthesia in dogs during three different total intravenous anaesthetic protocols and three anaesthetic depth levels as well as before and after electrical nociceptive stimulation. Material and methods: Seven beagle dogs (14.3 ± 1.7 kg) were used in a randomised experimental trial with a complete crossover design. Each dog went through all three anaesthetic protocols, which were propofol alone (group P) and propofol combined with dexmedetomidine (3 µg/kg/h, group PD) or remifentanil (18 µg/kg/h, group PR). Propofol was given using target-controlled infusion. Three anaesthetic depth levels (light, medium, deep) were defined by target concentrations for propofol in the blood and were adapted to the individual animal and treatment (mean of 7, 9 and 11 µg/ml, and in combination with dexmedetomidine or remifentanil, a mean of 3, 5 and 7 µg/ml). During each anaesthetic level, a standardised supramaximal nociceptive electric stimulus (50 Hz, 50 V, 10 ms) was applied medially to the right forearm. The bipolar-derived electrocardiogram (ECG) was recorded continuously. For each anaesthetic depth, the RR-intervals recorded 2 minutes before and after each stimulation were included in the statistical analysis. Using an HRV analytical program (Kubios HRV), the frequency domain HRV-parameters low (LF) and high (HF) frequency and the time-domain HRV-parameters RR-intervals, standard deviation of all RR-intervals (SDNN) and the square root of the mean of the sum of the squares of the differences between consecutive RR-intervals (RMSSD) were determined. Results: Neither the RR-intervals nor the currently available HRV-parameters which were derived from the RR-intervals were able to discriminate between the different anaesthetic depths levels. Nociception could only be represented by the RRintervals. Conclusion: Overall, the investigated standard HRV parameters offered no additional information for the monitoring of anaesthetic depths at the investigated, clinically used dose rates.

Schlüsselwörter

Hund - TIVA - Elektrokardiogramm - RR-Intervalle - Nozizeption

Keywords

Dog - TIVA - electrocardiogram - RR-intervals - nociception

Full Text

References

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