Heart rate variability may be more useful than pulse transit time for confirming successful caudal block under general anesthesia in children

• Published in: Anesthesia and pain medicine (Korean society of anesthesiologists) 2017, 12(2), , pp.140-146
• Main Authors: Song, In-Kyung, Ji, Sanghwan, Kim, Eun-Hee, Lee, Ji-Hyun, Kim, Jin-Tae, Kim, Hee-Soo
• Format: Article
• Language: English
• Subjects: 마취과학
• ISSN: 2383-7977; 1975-5171; 2383-7977
• DOI: 10.17085/apm.2017.12.2.140

Background: Confirming a successful caudal block is challenging in the pediatric population. Pulse transit time (PTT) may reflect the decrease in arterial resistance and may act as a potential indicator for confirming successful peripheral nerve or axial block. Heart rate variability (HRV) is also a possible candidate because it may be influenced by variation in sympathetic tone. We expected an increasing PTT pattern and change in HRV parameters after caudal block. Methods: We enrolled 27 male patients (range, 1–4 years old) who were scheduled for urological surgeries. Caudal block was performed with 1 ml/kg of 0.25% ropivacaine and 1 : 200,000 epinephrine under sevoflurane anesthesia after the surgery. Successful block was confirmed by auscultation and ultrasonography. PTT and HRV parameters, such as standard deviation of normal-to-normal intervals, root mean square of successive differences, very low-frequency power, low-frequency power (LF), high-frequency power (HF), LF/HF ratio, approximate entropy (ApEn) were calculated based on electrocardiography from 1 min before to 5 min after the block. Those variables were analyzed by repeated measures analysis of variance. Results: No significant change was found in PTT with time interval after caudal block. Heart rate and ApEn of the R-R interval decreased with time interval (P = 0.001, 0.033, respectively). Some HRV parameters showed notable changes, although statistically insignificant. Conclusions: The PTT pattern may not be an indicator for successful caudal block. However, heart rate with parameters of HRV analysis may be alternatives. KCI Citation Count: 1