Heart rate variability (HRV) is a predictor of mortality and morbidity after non-lethal cardiac ischemia, but the relation between preoperatively measured HRV and intra- and postoperative complications is sparsely studied and most recently reviewed in 2007. We, therefore, reviewed the literature regarding HRV as a predictor for intra- and postoperative complications and outcomes. We carried out a systematic review without meta-analysis. A PICO model was set up, and we searched PubMed, EMBASE, and CENTRAL. The screening was done by one author, but all authors performed detailed review of the included studies. We present data from studies on intraoperative and postoperative complications, which were too heterogeneous to warrant formal meta-analysis, and we provide a pragmatic review of HRV indices to facilitate understanding our findings. The review was registered in PROSPERO (CRD42021230641). We screened 2337 records for eligibility. 131 records went on to full-text assessment, 63 were included. In frequency analysis of HRV, low frequency to high frequency ratio could be a predictor for intraoperative hypotension in spinal anesthesia and lower total power could possibly predict intraoperative hypotension under general anesthesia. Detrended fluctuation analysis of HRV is a promising candidate for predicting postoperative atrial fibrillation. This updated review of the relation between preoperative HRV and surgical outcome suggests a clinically relevant role of HRV but calls for high quality studies due to methodological heterogeneity in the current literature. Areas for future research are suggested.

Perioperative management in patients suffering from systemic mastocytosis is challenging. Most recommendations regarding anesthetic management in these patients are based on clinical reports, and there are controversies about the use of rocuronium and sugammadex. We present a case report of a patient with systemic mastocytosis who was given sugammadex for rocuronium reversal. Tryptase levels were monitored during the first postoperative 24 h, without evidence of elevation. We also performed a systematic review to provide an overview of current evidence regarding the safety of using sugammadex in patients suffering from systemic mastocytosis. The search strategy included PubMed and Google Scholar. All studies published up to and including January 2021 concerning anesthetic management in systemic mastocytosis were included. Of the 122 articles located, 9 articles were included: 2 reviews and 7 case reports. Data from reviewed studies confirm that sugammadex can safely be administered in patients suffering from systemic mastocytosis.
Die perioperative Behandlung von Patienten mit systemischer Mastozytose ist eine Herausforderung. Die meisten Empfehlungen zur Anästhesiebehandlung von diesen Patienten basieren auf klinischen Berichten und es gibt Kontroversen über die Anwendung von Rocuronium und Sugammadex. Wir präsentieren einen Fallbericht über eine Patientin mit systemischer Mastozytose, der Sugammadex zur Rocuronium-Umkehr verabreicht wurde. Die Tryptasespiegel wurden während der ersten postoperativen 24 h überwacht, wobei keine Erhöhung dieser Tryptasespiegel beobachtet wurde. Es wurde auch ein systematisches Review durchgeführt, um einen Überblick über die aktuelle Evidenz zur Sicherheit der Anwendung von Sugammadex bei diesen Patienten zu geben. Die Suchstrategie umfasste PubMed und Google Scholar. Alle Studien zur Anästhesiebehandlung bei systemischer Mastozytose bis einschließlich Januar 2021 wurden eingeschlossen. Von den 122 gefundenen Artikeln wurden 9 Artikel aufgenommen: 2 Reviews und 7 Fallberichte. Die Daten aus überprüften Studien bestätigen, dass Sugammadex bei Patienten mit systemischer Mastozytose sicher verabreicht werden kann.