Reliability of Hypotension Detection with Noninvasive Radial Artery Beat-to-Beat versus Upper Arm Cuff BP Monitoring

Ron Dueck, M.D. (Anesthesiology, University of California, San Diego and VA San Diego Healthcare System, San Diego, CA), Leslie C. Jameson, M.D. (Anesthesiology, University of Colorado Health Science Center, School of Medicine, Denver, CO)

Presented at the Society for Technology in Anesthesia 2006 Annual Meeting. San Diego, CA January 17-21.

Introduction:

Two recent reports show increased mortality in surgical patients with hypotension during general anesthesia.^1,2 While comorbidity was a primary risk factor and hypotension a secondary variable, the importance of hypotension lies in the potential for reducing anesthetic/surgical risk in high risk surgical patients.² We therefore examined the reliability of prospectively recorded noninvasive automated oscillometric cuff BP versus noninvasive beat-to-beat radial artery BP monitoring.

Methods:

Severity and duration of serious intraoperative hypotensive episodes (systolic BP <85 mm Hg for >5 minutes) were recorded by oscillometric cuff BP and Tensys® T-Line® radial artery beat-to-beat BP on a laptop computer from 25 subjects who provided IRBapproved informed consent before surgery.

Results:

Tensys® T-Line® BP provided rapid demonstration of 18 hypotensive episodes of systolic BP <85 mm Hg for >5 minutes, while cuff BP showed 4 delayed and 4 missed hypotensive episodes due to timing of the cuff cycle. The duration of hypotension was indeterminate by cuff BP in a majority of hypotensive episodes.

Conclusions:

Beat-to-beat radial artery BP monitoring is more reliable for demonstrating significant intraoperative hypotension.

References:

• O'Reilly MO, Tremper KT, Shanks A, Kheterpal S, Campbell DA. Evaluating surgical outcomes using the NSQIP database and Intraoperative variables using an electronic anesthesia information system. ASA Abstracts 2005; A648
• Monk TG, Saini V, Weldon BC, Sigl JC. Anesthetic management and one-year mortality after noncardiac surgery. Anesth Analg 2005; 100:4-10

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* Mean ± SD