Continuous intra-arterial versus intermittent oscillometric arterial pressure monitoring and hypotension during induction of anaesthesia: the AWAKE randomised trial

‘If you don't take a temperature, you can't find a fever’: relevance to continuous arterial pressure monitoring

“…11 Several risk factors have been identified contributing to post-induction hypotension, such as preinduction blood pressure, emergency surgery, age, ASA physical status, comorbidities, and vasoactive medication (Table 1). 12e15 In this issue of the British Journal of Anaesthesia, Kouz and colleagues 16 describe a randomised trial that examined whether the cumulative amount of such post-induction hypotension could be reduced when the anaesthetist decided to place an arterial line before induction of anaesthesia. They clearly show that continuous intra-arterial pressure monitoring reduced both the severity and duration of hypotension during anaesthetic induction compared with intermittent oscillometric blood pressure monitoring, presumably because hypotension was detected and treated earlier.…”

“…They clearly show that continuous intra-arterial pressure monitoring reduced both the severity and duration of hypotension during anaesthetic induction compared with intermittent oscillometric blood pressure monitoring, presumably because hypotension was detected and treated earlier. 16 Anaesthetists seem to be reluctant to place arterial lines in an awake patient, although there is no obvious reason for this attitude except the fear of patient discomfort and pain. Yet, arterial punctures can be performed under local anaesthesia using ultrasound guidance, minimising these potential drawbacks.…”

“…21 For cardiac surgery or interventional procedures in cardiology and radiology, awake radial artery catheterisation is performed regularly and promoted because of improved clinical outcomes and improved patient comfort, compared with femoral access, which is also performed in awake patients in these cases. 22 With the results of Kouz and colleagues, 16 there is now a strong argument that if an arterial line is indicated, it should be placed before induction of anaesthesia.…”

“…The study by Kouz and colleagues 16 questions several aspects related to current clinical practice. Should we, if an arterial line is indicated, consider arterial catheterisation before induction of anaesthesia more often?…”

Effect of pneumatic leg compression on post‐induction hypotension in elderly patients undergoing robot‐assisted laparoscopic prostatectomy: a double‐blind randomised controlled trial

“…The pneumatic leg compression device was also installed before induction. Before induction of anaesthesia, invasive arterial blood pressure monitoring was established [16]. Anaesthesia was induced with intravenous thiopentone 5 mg.kg −1 , inhaled sevoflurane and a target‐controlled intravenous infusion of remifentanil with an effect‐site concentration of 3 ng.l −1 .…”