Pulse transit time as a quick predictor of a successful axillary brachial plexus block

Kortekaas, Minke C.; Niehof, Sjoerd P.; Velzen, Marit H. N. van; Galvin, Eilish M.; Huygen, Frank; Stolker, Robert Jan

doi:10.1111/j.1399-6576.2012.02746.x

Cited by 24 publications

(18 citation statements)

References 11 publications

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“…Because of this, several studies have been performed. Kortekaas et al ( 22 ) reported that the mean PTT difference increased significantly after a successful axillary brachial plexus blockade. They concluded that PTT is a reliable method to evaluate whether a brachial plexus block is going to be successful.…”

Section: Discussionmentioning

confidence: 99%

The Prolongation of Pulse Transit Time After a Stellate Ganglion Block: An Objective Indicator of a Successful Block

Kim

Cheong

Kong

et al. 2015

Pain Research and Management

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The relationship between the change of pulse transit time and the presence of clinical signs after stallate ganglion block (SGB) was investigated in patients with disorders mediated by the sympathetic nervous system. SGB is used for the treatment and diagnosis of these disorders; however, a successful objective marker does not exist. Therefore, identifying increased blood flow following SGB and determining whether pulse transit time could be used to verify the success of SBG would be a helpful resource.

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Section: Discussionmentioning

confidence: 99%

The Prolongation of Pulse Transit Time After a Stellate Ganglion Block: An Objective Indicator of a Successful Block

Kim

Cheong

Kong

et al. 2015

Pain Research and Management

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“…Because reliable non-invasive VTT measurements are difficult, as an alternative we measure the PTT. PTT can be used to assess a successful loco regional block of an extremity [ 9 , 10 ], to monitor vasomotor tone, and for assessment of autonomic nervous system response [ 11 ]. Another non-invasive measurement to estimate the VTT is the pulse wave velocity (PWV).…”

Section: Introductionmentioning

confidence: 99%

Small intra-individual variability of the pre-ejection period justifies the use of pulse transit time as approximation of the vascular transit

Kortekaas¹,

Velzen²,

Grüne³

et al. 2018

PLoS ONE

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BackgroundVascular transit time (VTT) is the propagation time of a pulse wave through an artery; it is a measure for arterial stiffness. Because reliable non-invasive VTT measurements are difficult, as an alternative we measure pulse transit time (PTT). PTT is defined as the time between the R-wave on electrocardiogram and arrival of the resulting pulse wave in a distal location measured with photoplethysmography (PPG). The time between electrical activation of the ventricles and the resulting pulse wave after opening of the aortic valve is called the pre-ejection period (PEP), a component of PTT. The aim of this study was to estimate the variability of PEP at rest, to establish how accurate PTT is as approximation of VTT.MethodsPTT was measured and PEP was assessed with echocardiography (gold standard) in three groups of 20 volunteers: 1) a control group without cardiovascular disease aged <50 years and 2) aged >50 years, and 3) a group with cardiovascular risk factors, defined as arterial hypertension, dyslipidemia, kidney failure and diabetes mellitus.ResultsPer group, the mean PEP was: 1) 58.5 ± 13.0 ms, 2) 52.4 ± 11.9 ms, and 3) 57.6 ± 11.6 ms. However, per individual the standard deviation was much smaller, i.e. 1) 2.0–5.9 ms, 2) 2.8–5.1 ms, and 3) 1.6–12.0 ms, respectively. There was no significant difference in the mean PEP of the 3 groups (p = 0.236).ConclusionIn conclusion, the intra-individual variability of PEP is small. A change in PTT in a person at rest is most probably the result of a change in VTT rather than of PEP. Thus, PTT at rest is an easy, non-invasive and accurate approximation of VTT for monitoring arterial stiffness.

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“…. Similarly, higher sensitivity and specificity were found for perfusion indices . However, even the simplest study (measuring skin temperature by simple touch) achieved a 92% sensitivity, with a positive predictive value of 95% .…”

Section: Testing Of Onset and Assessing Readiness For Surgerymentioning

confidence: 86%

“…. Other investigators have used measures of perfusion to gauge block success, including pulse transit time and perfusion or flow indices derived from the pulse oximeter .…”

Section: Testing Of Onset and Assessing Readiness For Surgerymentioning

confidence: 99%

Monitoring regional blockade

2017

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This review attempts to draw on the published literature to address three practical clinical questions. First, what means of testing the degree of regional blockade pre-operatively are available, and can eventual success or failure be determined soon after injection? Second, is it possible to predict if a block inserted after the induction of general anaesthesia will be effective when the patient wakes? Third, what features, and what duration, should cause concern when a block does not resolve as expected after surgery? Although the relevant literature is limited, we recommend testing of multiple sensory modalities before surgery commences; temperature and thermographic changes may offer additional early warning of success or failure. There are a number of existing methods of assessing nociception under general anaesthesia, but none has yet been applied to gauge the onset of a regional block. Finally, criteria for further investigation and neurological referral when block symptoms persist postoperatively are presented.

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Pulse transit time as a quick predictor of a successful axillary brachial plexus block

Abstract: PTT is a reliable, quick and objective method to assess whether axillary block is going to be successful or not.

Cited by 24 publications

References 11 publications

The Prolongation of Pulse Transit Time After a Stellate Ganglion Block: An Objective Indicator of a Successful Block

The Prolongation of Pulse Transit Time After a Stellate Ganglion Block: An Objective Indicator of a Successful Block

Small intra-individual variability of the pre-ejection period justifies the use of pulse transit time as approximation of the vascular transit

Monitoring regional blockade

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