<p>Comparison of blood pressure measurements in the upper and lower extremities versus arterial blood pressure readings in children under general anesthesia</p>

Abstract

PurposeTo compare invasive blood pressure (IBP) readings obtained from an arterial cannula with non-invasive blood pressure (NIBP) measurements from oscillometric cuffs on the upper and lower extremities of infants and children under general anesthesia.Patients and methodsPatients under 10 years of age were enrolled in our study if they were to receive general anesthesia with planned placement of a radial arterial cannula. At 5 mins intervals, IBP was measured using a fluid-coupled pressure transducer and NIBP was measured with two oscillometers with appropriately sized cuffs placed on the upper arm and lower leg, for 10 readings per patient.ResultsThe study enrolled 18 boys and 12 girls, ranging in age from 0 to 8 years. Across 300 data points, the absolute difference between the arm and invasive mean arterial pressure (MAP) measurements was 7±7 mmHg (range: 0–52 mmHg). The absolute difference between the leg and invasive MAP measurements was 8±8 mmHg (range: 0–52 mmHg). Although both non-invasive measurement sites demonstrated frequent deviation from invasive measurement, large deviations were more common when BP was measured at the leg (81 of 298 observations (27%) deviating by >10 mmHg) compared to the arm (60 of 300 observations (20%) deviating by >10 mmHg).ConclusionThe frequency of clinically significant NIBP deviation in children under general anesthesia supports the importance of IBP monitoring when hemodynamic fluctuations are likely and would be particularly detrimental. NIBP measured at the lower leg is more likely to result in clinically significant deviation from invasively measured MAP than NIBP values obtained from an upper arm.

Evaluation of the accuracy of oscillometric non-invasive blood pressure measurement at the ankle in children during general anesthesia

“…The authors reported a higher bias and wider limits of agreement than ours specially for the MAP (mean bias [95% limits of agreement]: -5 ± 11 [-26 to 16] mmHg), and the number of MAP readings with > 10 mmHg bias was 27%. However, several differences between our study and Hayes et al’s that might explain the differences between the findings of both [ 13 ]: the type of patients (we included patients without cardiac anomalies), type of surgery (noncardiac surgery), the larger sample size (86 versus 30 children) and subsequently the larger number of analyzed readings in our study. Finally we evaluated the accuracy of ankle blood pressure to detect hypotension using the AUC analysis.…”

“…Hayes et al [ 13 ] investigated the accuracy of ankle blood pressure in relation to invasive blood pressure as the reference standard in patients undergoing cardiothoracic surgery and reported that ankle blood pressure significantly deviated from the invasive measurement. The authors reported a higher bias and wider limits of agreement than ours specially for the MAP (mean bias [95% limits of agreement]: -5 ± 11 [-26 to 16] mmHg), and the number of MAP readings with > 10 mmHg bias was 27%.…”

A Case of Difficult Arterial Cannulation: Is Intra-Arterial Blood Pressure Monitoring an Absolute Requirement for Paediatric Liver Transplantation?

“…Studies suggest that under general anaesthesia, systolic blood pressures measured via NIBP tend to read higher than IABP [ 11 ]. The degree of variation can be considerable, but is within 10 mmHg in the majority of cases—this should be taken into account when interpreting measurements [ 12 ]. The evidence suggests that this discrepancy between NIBP and IABP is minimised when BP cuffs are placed on the upper arm when compared to other sites.…”

“…The evidence suggests that this discrepancy between NIBP and IABP is minimised when BP cuffs are placed on the upper arm when compared to other sites. In a small prospective study of children aged 0–8 undergoing general anaesthesia, Hayes et al found that differences in systolic NIBP and IABP of >10 mmHg were found in 20% of measurements recorded on the upper arm, compared to 27% of measurements recorded on the leg [ 12 ]. The importance of using appropriately sized BP cuffs in children cannot be over-emphasised, as a cuff that is too small will provide falsely high readings and a cuff that is too large will provide falsely low readings.…”

Current state of noninvasive, continuous monitoring modalities in pediatric anesthesiology

“…In children the soft, compliant pediatric arteries produce less augmentation of the signal than stiffer adult arteries. Also a reduced sympathetic tone and a relatively reduced blood volume in the lower limbs of small children may play a role [ 5 ▪ , 6 – 8 ].…”