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General Anesthesia Imposes Negative Effects on Heart Rate and Blood Pressure Regulation in Patients With a History of Head and Neck Radiation Therapy

Zheng, Gang MD*; Dong, Wenli MD, MS; Lewis, Carol M. MD, MPH

doi: 10.1213/ANE.0000000000002539
Cancer and Supportive Care: Original Clinical Research Report

BACKGROUND: Head and neck radiation therapy (HNRT) impairs baroreflex sensitivity, and it may potentiate the effects of anesthetics on heart rate (HR) and blood pressure (BP) regulation. Currently, the impacts of HNRT on HR and BP under anesthesia remain unclear.

METHODS: In this study, 472 patients with primary oral cavity or oropharyngeal cancer at all stages were examined. Half of the patients underwent HNRT plus surgery. The other half underwent surgery only and was matched with the treatment patients according to age, sex, and body mass index at a 1:1 ratio. The HRs and BPs in the 2 groups during anesthetic induction, skin incision, and emergence were compared retrospectively. A multivariable model of repeated measures with unstructured covariance structure was used to examine the associations of HNRT with intraoperative HRs and BPs after adjusting for baseline HR and BP, time, use of β-blockers, history of chemotherapy, and American Society of Anesthesiologists physical status score. BPs and HRs were collected every 5 minutes. The baseline HR and BP measurements were not included in the outcome vector and were only used as adjustment for baselines.

RESULTS: Compared with corresponding baseline values in controls, the baseline HR was significantly higher (P = .0012) and the baseline systolic BP was lower (P < .0001) in the treatment group. The baseline diastolic BP levels did not differ significantly (P = .6411). Fewer patients receiving HNRT than controls took β-blockers daily (17% vs 28%; P = .0041). Comparing the corresponding values in control and treatment groups, multivariable analysis revealed significant associations of HNRT with decreases in HR during anesthesia induction (−2.21 [95% confidence interval {CI}, −4.42 to −0.01]; P = .0492) and skin incision (−2.66 [95% CI, −5.16 to −0.16]; P = .0373) and of HNRT with decreases in systolic BP during anesthesia induction (−6.88 [95% CI, −10.99 to −2.78]; P = .0011) and skin incision (−15.87 [95% CI, −20.45 to −11.29]; P < .001). However, we observed a significant association of HNRT with decrease in diastolic BP only during skin incision (−6.50 [95% CI, −9.47 to −3.53]; P < .0001).

CONCLUSIONS: The significant finding in the study was that general anesthesia imposed a negative chronotropic effect on HR in the group given HNRT. Therefore, one should be watchful for bradycardia in these patients; particularly those with low BPs. Their hemodynamics may rapidly progress into an unstable status when bradycardia and hypotension develop altogether.

Published ahead of print September 28, 2017.

From the Departments of *Anesthesiology and Perioperative Medicine, Biostatistics, and Head and Neck Surgery, the University of Texas MD Anderson Cancer Center, Houston, Texas.

Published ahead of print September 28, 2017.

Accepted for publication August 31, 2017.

Funding: None.

The authors declare no conflicts of interest.

Reprints will not be available from the authors.

Address correspondence to Gang Zheng, MD, Department of Anesthesiology and Perioperative Medicine, Unit 409, the University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030. Address e-mail to

© 2017 International Anesthesia Research Society
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