doi:10.1016/S0165-1838(98)00176-3 
Copyright © 1999 Elsevier Science B.V. All rights reserved
Arterial tonometry in the measurement of the effects of innocuous mechanical stimulation of the neck on heart rate and blood pressure
Takahiro Fujimotoa, Brian Budgellb, c, Sae Uchidac, Atsuko Suzukic and Kazuko Meguroa, *
a Department of Anesthesiology, Tokyo Metropolitan Geriatric Hospital, Sakaecho 35-2, Itabashi-ku, Tokyo, 173-0015, Japan
b Royal Melbourne Institute of Technology University, General Building No. 7-7F, Shinbashi 6-20-1, Minato-ku, Tokyo, 105-0004, Japan
c Department of the Autonomic Nervous System, Tokyo Metropolitan Institute of Gerontology, Sakaecho 35-2, Itabashi-ku, Tokyo, 173-0015, Japan
Received 14 September 1998;
revised 23 October 1998;
accepted 23 October 1998.
Available online 4 March 1999.
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Abstract
Arterial tonometry was used to continuously monitor the effects on heart rate and blood pressure of a series of innocuous mechanical stimuli applied to the neck in conscious humans. The stimuli used were derived from procedures commonly employed in clinical examination and physical therapy of the neck. In alert subjects, the stimuli used generally caused small and sometimes statistically significant decreases in heart rate, systolic pressure and diastolic pressure. In alert subjects, statistically significant decreases in systolic and diastolic pressure were particularly associated with stimuli which involved full rotation of the neck. In the course of the prolonged series of stimuli, some subjects slept or reported being on the verge of sleep. In these subjects, the same stimuli produced mixed effects on heart rate and increases in systolic and diastolic pressure which were significantly different from the effects obtained in fully alert subjects.
Author Keywords: Autonomic nervous system; Arterial tonometry; Heart rate; Blood pressure; Somatic stimulation
Fig. 1. Representative recordings of heart rate (HR) and blood pressure (BP) from one subject both when alert (A and B) and when on the verge of sleep (C and D). Duration of stimulation is indicated by horizontal bars beneath recordings. Characteristically, as indicated in these recordings, heart rate and blood pressure were more labile in subjects who slept or reported being on the verge of sleep. When alert, this subject showed an anomalous reaction to the cold pressor test (B), i.e. increased blood pressure, but mild bradycardia. All other subjects in all other trials of the cold pressor test showed increased blood pressure and tachycardia.
Fig. 2. (A) Heart rate, (B) systolic pressure, (C) diastolic pressure (histograms/vertical bars indicate mean/S.E.M.). Responses to stimuli in alert subjects (upper panel) and subjects who slept or reported being on the verge of sleep (lower panel). Number of trials/number of subjects are indicated below the histograms. *P<0.05, **P<0.01 per paired t-test for the null hypothesis that there was no significant difference between prestimulus levels and the maximum change associated with stimulus. Stimuli are indicated by small Roman numerals in brackets as described in detail in the text. Touch—light bilateral suboccipital pressure, 45°—passive cervical rotation of 45°, 90°—passive cervical rotation to physiological limit (approximately 90°), M.P.—motion palpation, F.S.M.—factitious spinal manipulation, S.M.—cervical spinal manipulation, C.P.—cold pressor test.
Table 1. Numerical data from Fig. 2, i.e. mean±S.E.M. for responses in heart rate, systolic blood pressure and diastolic blood pressure
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