Chapter-26 Perioperative Monitoring of the Autonomic Nervous System

BOOK TITLE: Monitoring in Anesthesia and Critical Care

1. Moore Robert
2. Zimick Nicholas
3. Sharma Anshuman
Publishing Year
Author Affiliations
1. Stony Brook University Hospital; State University of New York School of Medicine, Stony Brook, New York, Washington University in St. Louis, St. Louis, Missouri, United States
2. New York Presbyterian Hospital, Columbia University Medical Center, New York, New York, United States
3. Institute of Quality Improvement, Research and Informatics, Washington University in St. Louis, St. Louis, Missouri, United States
Chapter keywords
Autonomic nervous system, ANS, electrodermal activity, EDA, digital pupillometry, pupil light response, heart rate variability, surgical stress index


This chapter describes multiple noninvasive methods for evaluating ANS function. In general, simplification of the typically complex balance between sympathetic and parasympathetic tone correlates with disease burden and has been shown to have prognostic value. The autonomic nervous system (ANS) is the dedicated portion of the central nervous system that regulates and integrates the functions of nearly all internal organs, including the heart, blood vessels, liver, kidney, skin, and pupils. Its primary purpose is maintaining homeostasis under normal conditions, as well as assisting the body’s response to a variety of stressful conditions. The complexity of the ANS has made its direct assessment and monitoring in the perioperative and critical care settings challenging. Clinicians have thus far relied on indirect assessment via components of perioperative monitoring established by the American Society of Anesthesiologists. A detailed discussion on the electrodermal activity and digital pupillometry or pupil light response has been provided in this chapter.

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