Abstract
BACKGROUND: Autonomic dysfunction is a risk factor for hypotension after anesthesia induction. Deceleration capacity of heart rate (DC) is a new method to evaluate autonomic function. This prospective observational study was designed to evaluate whether the deceleration capacity of heart rate measured by a 5-min preoperative Electrocardiogram (ECG) can reliably predict post-induction hypotension (PIH). METHODS: Patients aged 18 to 65 undergoing elective surgery with lower ASA status I or II were included in this study. DC, root mean square density (RMSSD) and low frequency/high frequency ratio (LF/HF) were calculated from 5-min segments of ECG measured in the quiet state before surgery. PIH was defined as mean arterial pressure (MAP) < 65 mmHg or a decrease of > 30% for at least 1 min from induction of anesthesia to 10 min after tracheal intubation. Patients were divided into PIH and non-PIH groups according to whether they developed PIH or not. RESULTS: A total of 141 patients were enrolled in this study, of whom 63 (44.7%) presented with PIH. The RMSSD (p = 0.036) and DC (p < 0.001) of the PIH group were smaller, and the LF/HF was higher (p = 0.039). After adjusting for confounding factors (Model 2), DC was identified as an independent predictor of PIH (Odds Ratio: 0.377). The receiver operating characteristic (ROC) analysis showed that DC had a good diagnostic value as a predictor (AUC: 0.777; 95%CI: 0.705–0.909; p < 0.001). CONCLUSIONS: These results suggest that DC measured by ECG 5 min before anesthesia can predict PIH to some extent in patients with ASA status I or II. TRIAL REGISTRATION: Chinese Clinical Trial Registry, identifier: ChiCTR2400094595, Date: 25/12/2024. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12871-025-03262-0.