From the Guidelines
The heart rate variability (80-120 bpm) during liposuction under local anesthesia in a 70-year-old female patient is likely a normal physiologic response and does not require specific intervention as long as blood pressure remains stable. Continue monitoring vital signs closely throughout the procedure. The premedication with Xanax (alprazolam), gabapentin, and Zofran (ondansetron) is appropriate for anxiety reduction, pain management, and nausea prevention. Heart rate fluctuations during procedures are common due to several factors including anxiety, pain, medication effects, and the body's normal stress response to surgery. Local anesthetics containing epinephrine can also cause temporary heart rate increases. If heart rate exceeds 120 bpm or hypotension develops, consider administering small doses of beta-blockers (like metoprolol 2.5-5mg IV) after ensuring adequate volume status, as suggested by the guidelines for perioperative cardiovascular evaluation and care for noncardiac surgery 1. For elderly patients, maintaining hemodynamic stability is important, so any interventions should be gentle and titrated carefully. Post-procedure, continue monitoring for at least 1-2 hours to ensure heart rate and blood pressure normalize before discharge. The guidelines from the American College of Cardiology and American Heart Association emphasize the importance of heart rate control in the perioperative period, particularly in patients with cardiovascular risk factors 1. However, the most recent and relevant guideline for this specific scenario is from 2007, which suggests that effective heart rate control with beta blockers should be targeted at less than 65 beats per minute 1. Given the patient's current heart rate variability and the absence of hypotension, the current management approach is appropriate, with close monitoring and readiness to intervene if necessary.
From the Research
Intraoperative Heart Rate Variability
- The patient's heart rate variability (HRV) is within the range of 80-120 without hypotension during liposuction under local anesthesia, and has been given Xanax, gabapentin, and zofran.
- A study on the effect of an oral anxiolytic medication on HRV and image quality found that HRV in patients who received alprazolam was statistically significantly lower than in controls 2.
- Another study found that reduced HRV carries an adverse prognosis in patients who have survived an acute myocardial infarction, highlighting the importance of HRV in clinical settings 3.
Medication Effects on HRV
- The administration of Xanax (alprazolam) has been shown to decrease HRV and improve image quality in patients undergoing MDCT coronary angiography 2.
- The use of beta-blockers has been found to improve parasympathetic tone and decrease the risk of cardiac events, particularly during morning hours 4.
- Gabapentin and zofran may also have effects on HRV, although the specific effects of these medications on HRV are not well-studied in the provided evidence.