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A six month old cross bred calf was presented with a swelling on lateral abdomen and diagnosed with lateral abdominal hernia, which underwent herniorrhaphy under general anaesthesia formed the subject of the study. The animal was administered with meloxicam @ 0.5 mg/kg body weight intravenously for pre-emptive analgesia. Thirty minutes later, xylazine @ 0.02 mg/kg and butorphanol @ 0.05 mg/kg, were administered intravenously. Upon sedation, the animal was administered with a loading dose of lignocaine @ 1 mg/kg body weight intravenously. Immediately following the loading dose of lignocaine, anaesthesia was induced using guaiphenesin @ 50 mg/kg and ketamine @ 2mg/kg intravenously. Following induction, anaesthesia was maintained using the prepared guaiphenesin-ketamine-lignocaine-butorphanol anaesthetic mixture as continuous rate infusion @ 3 ml/kg/hr. Indirect and direct blood pressure measurements were monitored and recorded. The non-invasive blood pressure values for systolic, diastolic and mean blood pressures did not differ significantly (p > 0.05) from those monitored invasively.

Background Measuring blood pressure in patients with obesity is challenging. The ClearSight™ finger cuff (FC) uses the vascular unloading technique to provide continuous non-invasive blood pressure measurements. We aimed to test the agreement of the FC with invasive radial arterial monitoring (INV) in patients with obesity. Methods Participants had a body mass index (BMI) ≥45 kg/m2 and underwent laparoscopic bariatric surgery. FC and INV measurements were obtained simultaneously every 5 min on each patient, following induction of anesthesia. Agreement over time was assessed using modified Bland-Altman plots and error grid analysis permitted clinical interpretation of the results. Four-quadrant plots allowed assessment of concordance in blood pressure changes. Results The 30 participants had a median (IQR) BMI of 50.2 kg/m2 (IQR 48.3–55.3). The observed bias (SD, 95% limits of agreement) for systolic blood pressure (SBP) was 14.3 mmHg (14.1, -13.4 – 42.0), 5.2 mmHg (10.9, -16.0 – 26.5) for mean arterial pressure (MAP) and 2.6 mmHg (10.8, -18.6 – 23.8) for diastolic blood pressure (DBP). Error grid analysis showed that the proportion of readings in risk zones A-E were 90.8, 6.5, 2.7, 0 and 0% for SBP and 91.4, 4.3, 4.3, 0 and 0% for MAP, respectively. Discordance occurred in ≤8% of pairs for consecutive change in SBP, MAP and DBP. Conclusions The vascular unloading technique was not adequately in agreement with radial arterial monitoring. Evaluation in a larger sample is required before recommending this technique for intraoperative monitoring of patients with BMI ≥45 kg/m2.

An algorithm derived from machine learning uses the arterial waveform to predict intraoperative hypotension some minutes before episodes, possibly giving clinician’s time to intervene and prevent hypotension. Whether the Hypotension Prediction Index works well with noninvasive arterial pressure waveforms remains unknown. We therefore evaluated sensitivity, specificity, and positive predictive value of the Index based on non-invasive arterial waveform estimates. We used continuous hemodynamic data measured from ClearSight (formerly Nexfin) noninvasive finger blood pressure monitors in surgical patients. We re-evaluated data from a trial that included 320 adults ≥ 45 years old designated ASA physical status 3 or 4 who had moderate-to-high-risk non-cardiac surgery with general anesthesia. We calculated sensitivity and specificity for predicting hypotension, defined as mean arterial pressure ≤ 65 mmHg for at least 1 min, and characterized the relationship with receiver operating characteristics curves. We also evaluated the number of hypotensive events at various ranges of the Hypotension Prediction Index. And finally, we calculated the positive predictive value for hypotension episodes when the Prediction Index threshold was 85. The algorithm predicted hypotension 5 min in advance, with a sensitivity of 0.86 [95% confidence interval 0.82, 0.89] and specificity 0.86 [0.82, 0.89]. At 10 min, the sensitivity was 0.83 [0.79, 0.86] and the specificity was 0.83 [0.79, 0.86]. And at 15 min, the sensitivity was 0.75 [0.71, 0.80] and the specificity was 0.75 [0.71, 0.80]. The positive predictive value of the algorithm prediction at an Index threshold of 85 was 0.83 [0.79, 0.87]. A Hypotension Prediction Index of 80–89 provided a median of 6.0 [95% confidence interval 5.3, 6.7] minutes warning before mean arterial pressure decreased to

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 +1 614 722 4200Fax +1 614 722 4203Email seth.hayes@nationwidechildrens.orgPurpose: 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

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 +1 614 722 4200Fax +1 614 722 4203Email seth.hayes@nationwidechildrens.orgPurpose: 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

Accurate noninvasive blood pressure (NIBP) measurement requires use of an appropriately sized cuff. We aimed to improve the perioperative allocation of NIBP cuffs in patients with Class II–III obesity. In the baseline evaluation, we measured the mid-arm circumference (MAC) of 40 patients with BMI &gt, 35 kg/m2, documenting the corresponding cuff allocated by pre-operative nurses. The intervention consisted of the introduction of cuff allocation based on MAC measurement and augmented NIBP cuff supplies. We completed a re-evaluation and evaluation of the intervention by staff survey, using 5-point Likert scales and free text comments. At baseline, the correct cuff was allocated in 9 of 40 patients (22.5%). During the intervention, education occurred in 54 (69.2%) peri-operative nursing staff. Upon re-evaluation, the correct cuff was allocated in 30 of 40 patients (75.0%), a statistically significant improvement (χ2 = 22.1, p &lt, 0.001). Ninety-three of 120 staff surveys were returned (78%). Eleven out of 18 preoperative staff surveyed (61.1%) felt confident measuring the arm and selecting the correct cuff. Six (33%) agreed that taking the arm measurement added a lot of extra work. Equipment shortages, accuracy concerns, and clinical workarounds were reported by staff. Our intervention increased the proportion of correct cuffs allocated, but equipment and practical issues persist with NIBP cuff selection in obese patients.

En el presente estudio se buscó determinar si existe una variación significativa en perros despiertos entre la presión arterial entre los cuatro miembros, incluyendo la cola. Las presiones arteriales diastólica, sistólica y media fueron tomadas, utilizando el equipo SunTech Medical®, mediante la técnica de oscilometría, en cada uno de los miembros y la cola de 17 caninos pacientes de una clínica de pequeños animales en Bogotá, Colombia. No se encontró diferencias significativas entre los valores de la presión arterial diastólica, sistólica y media entre cada uno de los miembros y la cola., This study aimed to determine possible significant variations in awake dogs in blood pressure between the four limbs, including the tail. The diastolic, systolic, and mean arterial pressures were taken using the SunTech Medical® equipment, using the oscillometry technique, in each of the limbs and the tail of 17 canine patients in a pet clinic in Bogotá, Colombia. No significant differences were found between the diastolic, systolic, and mean blood pressure values between each of the limbs and the tail.

Since both, hypotension and hypertension, can potentially impair the function of vital organs such as heart, brain, or kidneys, monitoring of arterial blood pressure (BP) is a mainstay of hemodynamic monitoring in acutely or critically ill patients. Arterial BP can either be obtained invasively via an arterial catheter or non-invasively. Non-invasive BP measurement provides either intermittent or continuous readings. Most commonly, an occluding upper arm cuff is used for intermittent non-invasive monitoring. BP values are then obtained either manually (by auscultation of Korotkoff sounds or palpation) or automatically (e.g., by oscillometry). For continuous non-invasive BP monitoring, the volume clamp method or arterial applanation tonometry can be used. Both techniques enable the arterial waveform and BP values to be obtained continuously. This article describes the different techniques for non-invasive BP measurement, their advantages and limitations, and their clinical applicability.

Objective To compare the simultaneous invasive and non-invasive measurements of blood pressure (IBP and NIBP) based upon the Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC II) database. Methods and results A total of 986 records and 26,942 blood pressure (BP) measurements were extracted from MIMIC II database. The mean values of invasive systolic and invasive diastolic blood pressure (ISBP and IDBP) were 111.2 ± 33.9 mm Hg and 59.9 ± 22.8 mm Hg respectively, and the values of non-invasive ones were 114.0 ± 23.4 mm Hg and 51.0 ± 14.9 mm Hg. The average differences of systolic and diastolic blood pressure were −2.8 mm Hg and 8.9 mm Hg between IBP and NIBP. The correlation coefficients were 0.60 between ISBP and NISBP and 0.45 between IDBP and NIDBP. The robust regression equations between IBP ( y ) and NIBP ( x ) showed y = 1.02 x − 2.95 for SBP ( R 2 = 0.60) and y = 0.77 x + 18.43 for DBP ( R 2 = 0.82). At the higher part of BP, IBP is larger than NIBP, and at the lower part of BP, IBP is less than NIBP. Conclusion Average invasive systolic blood pressure is lower than the non-invasive one and average invasive diastolic blood pressure is higher than the non-invasive one. The IBP shows good correlation with the NIBP. The invasive blood pressures can be estimated from non-invasive ones by the regression equations.