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Dias RA, de Faria Cardoso C, Ghimouz R, Nono DA, Silva JA, Acuna J, Baltatu OC, Campos LA. Quantitative cardiac autonomic outcomes of hydrotherapy in women during the first stage of labor. Front Med (Lausanne) 2023; 9:987636. [PMID: 36660001 PMCID: PMC9844258 DOI: 10.3389/fmed.2022.987636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/05/2022] [Indexed: 01/04/2023] Open
Abstract
Introduction Most hydrotherapy studies during childbirth report findings related to pain using a widespread set of subjective measures. In this study, ECG biomarkers as quantitative cardiac autonomic outcomes were used to assess the effects of warm shower hydrotherapy on laboring women during the first stage of labor. Methods This was a prospective single-blind cohort study on stage I delivering women. Their cardiac autonomic function was assessed using heart rate variability (HRV) measures during a deep breathing test using point-of-care testing comprised of an HRV scanner system with wireless ECG enabling real-time data analysis and visualization. Labor pain and anxiety were assessed using the Visual Analog Scale for Pain (VASP) and the Beck Anxiety Inventory (BAI). A total of 105 pregnant women in the first stage of labor who received warm shower hydrotherapy, intravenous analgesia (scopolamine + sodium dipyrone), or spinal anesthetic (bupivacaine + morphine) were enrolled. Results In women during the first stage of labor, parasympathetic modulation reflected through RMSSD (root mean square of successive RR interval differences) was significantly reduced by hydrotherapy and intravenous analgesia (before vs. after mean rank diff. 35.73 and 65.93, respectively, p < 0.05). Overall HRV (SDNN, standard deviation of RR intervals) was significantly decreased only by intravenous analgesia (before vs. after mean rank diff. 65.43, p < 0.001). Mean heart rate was significantly increased by intravenous analgesia, while spinal anesthesia reduced it, and hydrotherapy did not alter it (before vs. after mean rank diff. -49.35*, 70.38*, -24.20 NS , respectively, *p < 0.05, NS not significant). Conclusion This study demonstrates that warm shower therapy may impact the sympathovagal balance via parasympathetic withdrawal in women during the initial stage of labor. The findings of this study provide quantitative support for using warm shower hydrotherapy during labor via point-of-care testing. The dependability of hydrotherapy as a non-pharmacological treatment is linked to the completion of more clinical research demonstrating quantitative evidence via outcome biomarkers to support indications on stress and birth progress.
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Affiliation(s)
- Raquel Aparecida Dias
- Center of Innovation, Technology and Education (CITE) at Anhembi Morumbi University—Anima Institute, São José dos Campos Technology Park, São José dos Campos, Brazil
| | - Cláudia de Faria Cardoso
- Center of Innovation, Technology and Education (CITE) at Anhembi Morumbi University—Anima Institute, São José dos Campos Technology Park, São José dos Campos, Brazil
| | - Rym Ghimouz
- Fatima College of Health Sciences, Abu Dhabi, United Arab Emirates
| | - Daniel Alessander Nono
- Center for Special Technologies, National Institute for Space Research (INPE), São José dos Campos, Brazil
| | | | - Juan Acuna
- Department of Public Health and Epidemiology, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Ovidiu Constantin Baltatu
- Center of Innovation, Technology and Education (CITE) at Anhembi Morumbi University—Anima Institute, São José dos Campos Technology Park, São José dos Campos, Brazil,Department of Public Health and Epidemiology, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates,*Correspondence: Ovidiu Constantin Baltatu,
| | - Luciana Aparecida Campos
- Center of Innovation, Technology and Education (CITE) at Anhembi Morumbi University—Anima Institute, São José dos Campos Technology Park, São José dos Campos, Brazil,Department of Public Health and Epidemiology, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates,Luciana Aparecida Campos,
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Lehavi A, Golomb N, Leiba R, Katz Y(S, Raz A. One-minute heart rate variability - an adjunct for airway obstruction identification. Physiol Rep 2019; 7:e13948. [PMID: 30632302 PMCID: PMC6328920 DOI: 10.14814/phy2.13948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 11/12/2018] [Accepted: 11/15/2018] [Indexed: 11/24/2022] Open
Abstract
Heart rate variability (HRV) reflects cardiac and autonomic nervous system activity. It is usually measured over a relatively prolonged period and presented using multiple parameters. Here, we studied rapid HRV changes during airway obstruction using a short (1 min) sampling window. Forty healthy volunteers underwent a trial of obstructed breathing. Heart rate was recorded during three consecutive sets comprised of 1-min control followed by 1 min of obstructed breathing, with 1 min of rest between sets. Time and frequency domain analysis were used to compare HRV during control versus obstructed breathing. Compared with control, HRV intensely increased during obstructed breathing: R-R intervals (time between consecutive R waves) standard deviation increased from 65 to 108 msec (P < 0.0001), root mean square of successive R-R interval from 61 to 82 msec (P = 0.001), number of pairs of successive R-R intervals that differ by more than 50 msec (NN50) from 16.5 to 25.3 events (P < 0.0001), and proportion of NN50 divided by total number of R-R intervals from 26.6 to 35.1% (P = 0.001). Low frequency power increased by more than fourfold (P < 0.0001), allowing 90% sensitivity and 75% specificity for identifying airway obstruction (ROC area 0.88, P < 0.0001). We observed a rapid intense increase in HRV during obstructed breathing, significant enough to detect during a short 1-min sampling window. These findings suggest that HRV may be useful for rapid detection of airway obstruction, especially in situations where end-tidal CO2 monitoring is not optimal, such as during partial airway obstruction.
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Affiliation(s)
- Amit Lehavi
- Department of AnesthesiologyRambam Health Care Campusthe Ruth and Bruce Rappaport Faculty of MedicineTechnion – Israel Institute of TechnologyHaifaIsrael
| | - Neta Golomb
- Department of AnesthesiologyRambam Health Care Campusthe Ruth and Bruce Rappaport Faculty of MedicineTechnion – Israel Institute of TechnologyHaifaIsrael
| | - Ronit Leiba
- Department of EpidemiologyRambam Health Care Campusthe Ruth and Bruce Rappaport Faculty of MedicineTechnion – Israel Institute of TechnologyHaifaIsrael
| | - Yeshayahu (Shai) Katz
- Department of AnesthesiologyRambam Health Care Campusthe Ruth and Bruce Rappaport Faculty of MedicineTechnion – Israel Institute of TechnologyHaifaIsrael
| | - Aeyal Raz
- Department of AnesthesiologyRambam Health Care Campusthe Ruth and Bruce Rappaport Faculty of MedicineTechnion – Israel Institute of TechnologyHaifaIsrael
- Department of AnesthesiologyUniversity of WisconsinMadisonWisconsin
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Gonçalves H, Pinto P, Silva M, Ayres-de-Campos D, Bernardes J. Electrocardiography versus photoplethysmography in assessment of maternal heart rate variability during labor. SPRINGERPLUS 2016; 5:1079. [PMID: 27462527 PMCID: PMC4945517 DOI: 10.1186/s40064-016-2787-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 07/06/2016] [Indexed: 11/10/2022]
Abstract
Purpose Evaluation of maternal heart rate (MHR) variability provides useful information on the maternal-fetal clinical state. Electrocardiography (ECG) is the most accurate method to monitor MHR but it may not always be available, and pulse oximetry using photoplethysmography (PPG) can be an alternative. In this study we compared ECG and PPG signals, obtained with conventional fetal monitors, to evaluate signal loss, MHR variability indices, and the ability of the latter to predict fetal acidemia and operative delivery. Methods Both signals were simultaneously acquired in 51 term pregnancies during the last 2 h of labor (H1 and H2). Linear time- and frequency-domain, and nonlinear MHR variability indices were estimated, and the dataset was divided into normal and acidemic cases, as well as into normal and operative deliveries. Differences between ECG and PPG signals were assessed using non-parametric confidence intervals, hypothesis testing, correlation coefficient and a measure of disagreement. Prediction of fetal acidemia and operative delivery was assessed using areas under the receiver operating characteristic curve (auROC). Results Signal loss was higher with ECG during the first segments of H1, and higher with PPG in the last segment of H2, and it increased in both signals with labour progression. MHR variability indices were significantly different when acquired with ECG and PPG signals, with low correlation coefficients and high disagreement for entropy and fast oscillation-based indices, and low disagreement for the mean MHR and slow oscillation-based indices. However, both acquisition modes evidenced significant differences between H1 and H2 and comparable auROC values were obtained in the detection of fetal acidemia and operative vaginal delivery. Conclusion Although PPG captures the faster oscillations of the MHR signal less well than ECG and is prone to have higher signal loss in the last 10-min preceding delivery, it can be considered an alternative for MHR monitoring during labor, with adaptation of cut-off values for MHR variability indices.
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Affiliation(s)
- Hernâni Gonçalves
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Rua Dr Plácido da Costa, s/n, 4200-450 Porto, Portugal
| | - Paula Pinto
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Rua Dr Plácido da Costa, s/n, 4200-450 Porto, Portugal ; Department of Obstetrics and Gynecology, Medical School, University of Porto, Porto, Portugal ; Hospital Dr Nélio Mendonça, EPE, Funchal, Portugal
| | - Manuela Silva
- Department of Obstetrics and Gynecology, Medical School, University of Porto, Porto, Portugal
| | - Diogo Ayres-de-Campos
- Department of Obstetrics and Gynecology, Medical School, University of Porto, Porto, Portugal ; Department of Obstetrics and Gynecology, São João Hospital, Porto, Portugal ; INEB - Institute of Biomedical Engineering, Porto; I3S - Institute for Research and Innovation in Health, University of Porto, Porto, Portugal
| | - João Bernardes
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Rua Dr Plácido da Costa, s/n, 4200-450 Porto, Portugal ; Department of Obstetrics and Gynecology, Medical School, University of Porto, Porto, Portugal ; Department of Obstetrics and Gynecology, São João Hospital, Porto, Portugal ; Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Senhora da Hora, Portugal
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Liu XB, Pan S, Yang XG, Li ZW, Sun QS, Zhao Z, Ma HC, Cui CR. Effect of penehyclidine hydrochloride on heart rate variability in hysteroscopy. Exp Ther Med 2015; 10:181-186. [PMID: 26170932 DOI: 10.3892/etm.2015.2497] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Accepted: 12/23/2014] [Indexed: 11/06/2022] Open
Abstract
In order to evaluate the effect of different doses of penehyclidine hydrochloride (penehyclidine) on heart rate (HR) and HR variability (HRV) in hysteroscopy, 180 patients (American Society of Anesthesiologists grade I-II) were randomized equally to three groups: 0.5 mg penehyclidine and intravenous anesthesia (group I), 1.0 mg penehyclidine and intravenous anesthesia (group II) and saddle anesthesia combined with intravenous anesthesia (control group). HR and HRV, including total power (TP), low-frequency power (LF), high-frequency power (HF) and the LF to HF ratio (LF/HF), were recorded prior and subsequent to the induction of anesthesia (T0 and T1, respectively), following the start of surgery (T2) and following completion of surgery (T3). HR was lower at T2 than at T0 in the control patients, but no differences were observed in groups I and II. The HR at T2 was increased in group II compared with that in group I. TP in group II was significantly higher compared with that in group I at T2. At T1 and at T2, the LF and HF values were lower in group I than those in the controls. Patients in group II also had higher LF and HF at T2 than patients in group I. The HF was higher at T2 than that at T0 in the controls; however, the HF and LF did not change significantly within groups I and II. No significant differences were observed in the LF/HF ratio among the three groups. At a dose of 0.5 mg, penehyclidine stabilized HRV and did not alter the autonomic nervous modulation of HR. A penehyclidine dose of 1.0 mg may be superior to a dose of 0.5 mg in maintaining HR, but is less effective at balancing sympathetic and parasympathetic activity.
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Affiliation(s)
- Xiao-Bo Liu
- Department of Anesthesiology, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Shu Pan
- Department of Anesthesiology, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Xi-Ge Yang
- Department of Anesthesiology, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Zhi-Wen Li
- Department of Anesthesiology, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Qing-Shan Sun
- Department of Anesthesiology, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Zhuang Zhao
- Department of Anesthesiology, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Hai-Chun Ma
- Department of Anesthesiology, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Cheng-Ri Cui
- Department of Anesthesiology, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
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Moy KV, Ma JD, Best BM, Atayee RS. Factors impacting variability of the urinary normeperidine-to-meperidine metabolic ratio in patients with chronic pain. J Anal Toxicol 2013; 38:1-7. [PMID: 24133175 DOI: 10.1093/jat/bkt087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Meperidine (Demerol(®)) is a mu- and kappa-opiate receptor agonist used for moderate to severe pain. Overdose can result in respiratory depression, hypotension and coma, while accumulation of its toxic metabolite, normeperidine, can cause delirium and seizures. Little data exist examining the inter- and intrasubject variability of the normeperidine-to-meperidine metabolic ratio (MR) in urine. This retrospective data analysis examined meperidine and normeperidine urine concentrations collected from chronic pain patients. In 98 subjects with multiple visits, the geometric mean urinary MR = 6.1 (coefficient of variation, %CV = 68%). From single specimens obtained from 799 subjects, the geometric mean urinary MR = 6.2 (%CV = 212%). The urinary MR increased in young subjects compared with elderly (P = 0.004) and middle-aged subjects (P = 0.01). A 27% difference was found between the male and female urinary MR (male geometric mean MR = 5.1, female geometric mean MR = 7.0, P = 0.02). Intersubject variability in meperidine metabolism was 3-fold greater than intrasubject variability. A significant difference in the urinary MR was found between males and females. The substantial variability in meperidine metabolism and the serious side effects of its metabolite normeperidine require greater vigilance in patient medication monitoring.
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Affiliation(s)
- Katie V Moy
- 1Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego (UC San Diego), 9500 Gilman Drive, MC 0719, La Jolla, CA 92093-0719, USA
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The Analgesia Nociception Index: a pilot study to evaluation of a new pain parameter during labor. Int J Obstet Anesth 2012; 21:146-51. [DOI: 10.1016/j.ijoa.2012.01.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2010] [Revised: 12/28/2011] [Accepted: 01/03/2012] [Indexed: 11/18/2022]
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