Hypertension
Conditions
Keywords
heart rate variability, cervical myelopathy, blood pressure, decompression
Brief summary
Myelopathy from cervical cord compression may induce hypertension and sympathetic hyperactivity. Anesthesia may suppress sympathetic activity and lead to hypotension that require vasopressor treatment. We aim to elucidate the causative factors for severe hypotension during anesthesia by prospective observational study.
Detailed description
It had been reported the cervical spondylotic myelopathy may lead to the development of hypertension. Decompression surgeries ameliorated neurological symptoms as well as the blood pressure. The cause may be the abnormality of autonomic dysfunction developed after myelopathy. However, the evidence was weak. We have noticed a tendency of hypotension during anesthesia in patients undergroing cervical spine surgeries, especially in surgeries of long levels and hypertensive patients. Thus we postulate the autonomic activity is abnormal in patients with cervical myelopathy. Sympathetic hyperactivity developed in order to maintain adequate perfusion to the cervical cord. When patients are under anesthesia, the sympathetic tone is suppressed, thus leading to severe hypotension that require the treatment of inotropic treatment. Heart rate variability (HRV) is a good index of autonomic activity. Thus we plan to Therefore we will measure the HRV (analysis of ECG) and baroreflex activity (analysis of arterial line during the anesthesia) in patients undergoing cervical spine surgeries for decompression of cord compression perioperatively. The primary end-point is the comparison of severity of cord compression between normotensive and hypertensive patients with cervical myelopathy. The secondary end-point is to compare blood pressure and HRV pre- and postoperatively. The third end-point is to elucidate the causative factors for severe hypotension during anesthesia.
Interventions
PROCEDUREDecompression surgery
The surgeries aim to relieve the myelopathy from cord compression
Sponsors
Taipei Veterans General Hospital, Taiwan
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
20 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
* cervical spine surgery for cord compression
Exclusion criteria
* spinal cord injury * ASA class \>3 * chronic kidney disease * congestive heart failure * BMI\>30 * atrial fibrillation/ flutter * obstructive sleep apnea
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| change of blood pressure | one day before surgery, during surgery, 3 months after surgery, 6 months after surgery | noninvasive blood pressure |
| change of hear rate variability | one day before surgery, during surgery, 3 months after surgery, 6 months after surgery | from analysis of ECG |
| baroreflex activity | during surgery (anesthesia) | from analysis of arterial blood pressure waveform |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| change of Japanese Orthopaedic Association Scores | one day before surgery, 3 months after surgery, 6 months after surgery | 17 points neurological assessment for cervical spine pathology (from 0\ 17; 0 denotes worst neurological condition, 17 denotes intact ) |
| change of the Nurick scores | one day before surgery, 3 months after surgery, 6 months after surgery | 6 grades neurological assessment for cervical spine pathology (Grade 0: no root or cord symptoms; 1, signs or symptoms of root involvement only; 2, signs of spinal cord involvement (normal gait); 3, mild gait abnormality (does not prevent employment); 4, gait abnormality prevents employment; 5, only able to walk with assistance; 6, chair bound or bedridden) |
Countries
Taiwan
Contacts
Primary ContactYa-Chun Chu, MD, PhD
Backup ContactWen-Cheng HUANG, MD, PhD
Outcome results
None listed