caa a22 4500 605510083 CHVBK 20210128100644.0 cr unu---uuuuu 210128e20150601xx s 000 0 eng 10.1007/s10877-014-9617-z doi (NATIONALLICENCE)springer-10.1007/s10877-014-9617-z Can short-term heart rate variability be used to monitor fentanyl-midazolam induced changes in ANS preceding respiratory depression? [Elektronische Daten] [Anne-Louise Smith, Harry Owen, Karen Reynolds] Opioids have an occasional but high-risk side effect of respiratory depression. The detection of critical respiratory depression usually occurs after the event. Earlier detection would be beneficial in preventing increased morbidity and mortality of 0.01% patients receiving analgesic opioids. Airway patency during inspiration requires vagal modulation. Regulation of the cardiovascular and respiratory centres may be coupled with a central mechanism that is indirectly measurable with heart rate variability (HRV). While opioids tend to increase parasympathetic tone, a decrease in airway stability could be due to a decrease in respiratory parasympathetic activity. Sympathetic arousal generated by apneic events may separately be recognised with short-term HRV. This pilot observational study examined the dynamic sympathovagal changes during fentanyl-midazolam induced respiratory depression on 10 subjects scheduled for minor surgery. A selection of HRV indices, able to work over sub-minute periods on non-stationary signals, were applied including a range of less common indices. Three analyses tested the effects: post-fentanyl, preceding the first central depression, and preceding obstruction of the upper airway. Statistical significance was assessed with overlap of bootstrap percentile confidence intervals for the median. A decrease in total variability, Lomb Total using the Lomb-Scargle method, is a positive finding for short-term HRV use in this study. No significant change before critical respiratory events was observed in traditional, spectral power, respiratory or other indices. One index, PolVar20, indicated a burst of sympathetic activity preceding respiratory depression similar to sleep apnoea arousals that restore airway patency. Before its usefulness in early detection of airway tone can be determined, PolVar20 requires further work: a statistical method for highly skewed distributions, auto adjustment for baseline variability, and detecting a range of sympathetic responses to apnea. Springer Science+Business Media New York, 2014 Autonomic nervous system (ANS) modulation nationallicence Biomedical signal processing nationallicence Heart rate variability (HRV) nationallicence Fentanyl nationallicence Midazolam nationallicence Airway collapse nationallicence Smith Anne-Louise The Medical Device Research Institute, Flinders University, GPO Box 2100, 5001, Adelaide, SA, Australia aut Owen Harry School of Medicine, Flinders University, GPO Box 2100, 5001, Adelaide, SA, Australia aut Reynolds Karen The Medical Device Research Institute, Flinders University, GPO Box 2100, 5001, Adelaide, SA, Australia aut Journal of Clinical Monitoring and Computing Springer Netherlands 29/3(2015-06-01), 393-405 1387-1307 29:3<393 2015 29 10877 https://doi.org/10.1007/s10877-014-9617-z text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s10877-014-9617-z text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Smith Anne-Louise The Medical Device Research Institute, Flinders University, GPO Box 2100, 5001, Adelaide, SA, Australia aut NATIONALLICENCE 700 1- Owen Harry School of Medicine, Flinders University, GPO Box 2100, 5001, Adelaide, SA, Australia aut NATIONALLICENCE 700 1- Reynolds Karen The Medical Device Research Institute, Flinders University, GPO Box 2100, 5001, Adelaide, SA, Australia aut NATIONALLICENCE 773 0- Journal of Clinical Monitoring and Computing Springer Netherlands 29/3(2015-06-01), 393-405 1387-1307 29:3<393 2015 29 10877