Effect of conscious sedation on cardiac autonomic regulation during colonoscopy

M Ristikankare, R Julkunen, Tomi Laitinen, S X Wang, M Heikkinen, E Janatuinen, J Hartikainen

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

BACKGROUND: Colonoscopy is associated with cardiovascular events including hypotension, hypertension, and myocardial ischemia. The pathogenetic mechanisms of these cardiovascular events are unknown, but there is evidence that the autonomic nervous system may play a role. Conscious sedation is often used to relieve the inconvenience caused by the procedure. In this study, we evaluated the effects of sedation on cardiac autonomic regulation during colonoscopy.

METHODS: One hundred and eighty patients undergoing elective colonoscopy were prospectively randomized into three groups: (i) sedation with intravenous midazolam (midazolam group); (ii) sedation with intravenous saline (placebo group); and (iii) no intravenous cannula (control group). Continuous electrocardiogram was recorded prior to, during, and after the colonoscopic procedure. Heart rate variability (HRV) was assessed by means of the power spectral analysis; the powers of low-frequency (LF 0.04-0.15 Hz) and high-frequency (HF 0.15-0.40 Hz) components were calculated.

RESULTS: Intubation of the colonoscope increased the LF component of HRV and decreased HF power in all study groups compared to baseline recording. Furthermore, compared to baseline, the LF/HF ratio--a marker of cardiac sympathetic regulation--increased during intubation in the midazolam (P < 0.001) and placebo (P < 0.05) groups, with no change in the control group. During intubation the midazolam group presented with higher LF and lower HF power than placebo (P < 0.001) and control groups (P < 0.01). Accordingly, the LF/HF ratio was higher in the midazolam group than in the placebo (P < 0.05) or control groups (P < 0.05).

CONCLUSIONS: Midazolam potentiates the dominance of the sympathetic nervous system induced by colonoscopy. Therefore, conscious sedation with midazolam may contribute to the occurrence of cardiovascular events during colonoscopy.

Original languageEnglish (US)
Pages (from-to)990-6
Number of pages7
JournalScandinavian Journal of Gastroenterology
Volume35
Issue number9
StatePublished - Sep 2000

Fingerprint

Conscious Sedation
Midazolam
Colonoscopy
Placebos
Intubation
Control Groups
Heart Rate
Colonoscopes
Autonomic Nervous System
Sympathetic Nervous System
Hypotension
Myocardial Ischemia
Electrocardiography
Hypertension

Keywords

  • Colonoscopy
  • Conscious Sedation
  • Electrocardiography
  • Female
  • Heart
  • Heart Rate
  • Humans
  • Hypnotics and Sedatives
  • Male
  • Midazolam
  • Middle Aged
  • Monitoring, Physiologic
  • Premedication
  • Prospective Studies
  • Clinical Trial
  • Journal Article
  • Randomized Controlled Trial

Cite this

Ristikankare, M., Julkunen, R., Laitinen, T., Wang, S. X., Heikkinen, M., Janatuinen, E., & Hartikainen, J. (2000). Effect of conscious sedation on cardiac autonomic regulation during colonoscopy. Scandinavian Journal of Gastroenterology, 35(9), 990-6.

Effect of conscious sedation on cardiac autonomic regulation during colonoscopy. / Ristikankare, M; Julkunen, R; Laitinen, Tomi; Wang, S X; Heikkinen, M; Janatuinen, E; Hartikainen, J.

In: Scandinavian Journal of Gastroenterology, Vol. 35, No. 9, 09.2000, p. 990-6.

Research output: Contribution to journalArticle

Ristikankare, M, Julkunen, R, Laitinen, T, Wang, SX, Heikkinen, M, Janatuinen, E & Hartikainen, J 2000, 'Effect of conscious sedation on cardiac autonomic regulation during colonoscopy', Scandinavian Journal of Gastroenterology, vol. 35, no. 9, pp. 990-6.
Ristikankare M, Julkunen R, Laitinen T, Wang SX, Heikkinen M, Janatuinen E et al. Effect of conscious sedation on cardiac autonomic regulation during colonoscopy. Scandinavian Journal of Gastroenterology. 2000 Sep;35(9):990-6.
Ristikankare, M ; Julkunen, R ; Laitinen, Tomi ; Wang, S X ; Heikkinen, M ; Janatuinen, E ; Hartikainen, J. / Effect of conscious sedation on cardiac autonomic regulation during colonoscopy. In: Scandinavian Journal of Gastroenterology. 2000 ; Vol. 35, No. 9. pp. 990-6.
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T1 - Effect of conscious sedation on cardiac autonomic regulation during colonoscopy

AU - Ristikankare, M

AU - Julkunen, R

AU - Laitinen, Tomi

AU - Wang, S X

AU - Heikkinen, M

AU - Janatuinen, E

AU - Hartikainen, J

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N2 - BACKGROUND: Colonoscopy is associated with cardiovascular events including hypotension, hypertension, and myocardial ischemia. The pathogenetic mechanisms of these cardiovascular events are unknown, but there is evidence that the autonomic nervous system may play a role. Conscious sedation is often used to relieve the inconvenience caused by the procedure. In this study, we evaluated the effects of sedation on cardiac autonomic regulation during colonoscopy.METHODS: One hundred and eighty patients undergoing elective colonoscopy were prospectively randomized into three groups: (i) sedation with intravenous midazolam (midazolam group); (ii) sedation with intravenous saline (placebo group); and (iii) no intravenous cannula (control group). Continuous electrocardiogram was recorded prior to, during, and after the colonoscopic procedure. Heart rate variability (HRV) was assessed by means of the power spectral analysis; the powers of low-frequency (LF 0.04-0.15 Hz) and high-frequency (HF 0.15-0.40 Hz) components were calculated.RESULTS: Intubation of the colonoscope increased the LF component of HRV and decreased HF power in all study groups compared to baseline recording. Furthermore, compared to baseline, the LF/HF ratio--a marker of cardiac sympathetic regulation--increased during intubation in the midazolam (P < 0.001) and placebo (P < 0.05) groups, with no change in the control group. During intubation the midazolam group presented with higher LF and lower HF power than placebo (P < 0.001) and control groups (P < 0.01). Accordingly, the LF/HF ratio was higher in the midazolam group than in the placebo (P < 0.05) or control groups (P < 0.05).CONCLUSIONS: Midazolam potentiates the dominance of the sympathetic nervous system induced by colonoscopy. Therefore, conscious sedation with midazolam may contribute to the occurrence of cardiovascular events during colonoscopy.

AB - BACKGROUND: Colonoscopy is associated with cardiovascular events including hypotension, hypertension, and myocardial ischemia. The pathogenetic mechanisms of these cardiovascular events are unknown, but there is evidence that the autonomic nervous system may play a role. Conscious sedation is often used to relieve the inconvenience caused by the procedure. In this study, we evaluated the effects of sedation on cardiac autonomic regulation during colonoscopy.METHODS: One hundred and eighty patients undergoing elective colonoscopy were prospectively randomized into three groups: (i) sedation with intravenous midazolam (midazolam group); (ii) sedation with intravenous saline (placebo group); and (iii) no intravenous cannula (control group). Continuous electrocardiogram was recorded prior to, during, and after the colonoscopic procedure. Heart rate variability (HRV) was assessed by means of the power spectral analysis; the powers of low-frequency (LF 0.04-0.15 Hz) and high-frequency (HF 0.15-0.40 Hz) components were calculated.RESULTS: Intubation of the colonoscope increased the LF component of HRV and decreased HF power in all study groups compared to baseline recording. Furthermore, compared to baseline, the LF/HF ratio--a marker of cardiac sympathetic regulation--increased during intubation in the midazolam (P < 0.001) and placebo (P < 0.05) groups, with no change in the control group. During intubation the midazolam group presented with higher LF and lower HF power than placebo (P < 0.001) and control groups (P < 0.01). Accordingly, the LF/HF ratio was higher in the midazolam group than in the placebo (P < 0.05) or control groups (P < 0.05).CONCLUSIONS: Midazolam potentiates the dominance of the sympathetic nervous system induced by colonoscopy. Therefore, conscious sedation with midazolam may contribute to the occurrence of cardiovascular events during colonoscopy.

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KW - Electrocardiography

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KW - Heart

KW - Heart Rate

KW - Humans

KW - Hypnotics and Sedatives

KW - Male

KW - Midazolam

KW - Middle Aged

KW - Monitoring, Physiologic

KW - Premedication

KW - Prospective Studies

KW - Clinical Trial

KW - Journal Article

KW - Randomized Controlled Trial

M3 - Article

VL - 35

SP - 990

EP - 996

JO - Scandinavian Journal of Gastroenterology

JF - Scandinavian Journal of Gastroenterology

SN - 0036-5521

IS - 9

ER -