Objective To investigate the impacts of different depth of anesthesia on heart rate variability (HRV) and hemodynamics in middle-aged and elderly patients undergoing laparoscopic cholecystectomy (LC). Methods A total of 164 middle-aged and elderly patients who underwent LC in Yuncheng Central Hospital of Shanxi Province from January 2020 to December 2024 were enrolled. According to the bispectral index (BIS), patients were divided into three groups: mild anesthesia (BIS: 50-59, n=55), moderate anesthesia (BIS: 40-49, n=55), and deep anesthesia (BIS: 30-39, n=54). HRV and hemodynamic parameters were recorded at four time points: before anesthesia induction (T1), immediately after intubation (T2), 3 min after intubation (T3) and 6 min after extubation (T4). Anesthesia recovery time, levels of pain-related stress markers, cognitive function and the incidence of adverse reactions were compared among all groups. Results Significant differences were observed among the three groups in HRV indices (HFP, LFP/HFP and TP) and hemodynamic parameters (HR, MAP, DBP and SBP) at T2 to T4. The moderate anesthesia group showed smaller fluctuations in HRV and hemodynamic measures compared to the mild and deep anesthesia groups. In addition, patients in the moderate anesthesia group had significantly shorter recovery times (spontaneous respiration, eye opening, extubation, orientation recovery, and post-anesthesia care unit discharge), higher cognitive function scores, and lower levels of pain-related stress markers (AD, NE, and Cor) than those in the other two groups. There were no significant differences in the incidence of adverse reactions among the three groups. Conclusion Maintaining BIS within 40-49 during surgery has little impact on perioperative HRV and hemodynamics in middle-aged and elderly patients undergoing LC, and is associated with postoperative recovery. This suggests that under the conditions of this study, a BIS range of 40-49 may be beneficial, though prospective or multicenter validation is still required.
Key words
anesthesia depth /
heart rate variability /
hemodynamics /
laparoscopic cholecystectomy /
perioperative period
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