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

Abstract

Seth Hayes,1 Rebecca Miller,1 Ambrish Patel,2,3 Dmitry Tumin,1,2 Hina Walia,1 Mohammed Hakim,1 Faizaan Syed,1 Joseph D Tobias1,2,41Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Columbus, OH 43205, USA; 2Department of Pediatrics, The Ohio State University, Columbus, OH 43210, USA; 3Division of Pediatric Critical Care, Nationwide Children’s Hospital, Columbus, OH 43205, USA; 4Department of Anesthesiology and Pain Medicine, The Ohio State University, Columbus, OH 43210, USACorrespondence: Seth HayesDepartment of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, USATel [phone]Fax [phone]Email [email protected]: To 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 methods: Patients 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.Results: The 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).Conclusion: The 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.Keywords: invasive blood pressure, non-invasive blood pressure, blood pressure cuff

Keywords

• Invasive blood pressure
• Non-invasive blood pressure
• Blood pressure cuff