Comparing oscillometric noninvasive and invasive intra‐arterial blood pressure monitoring in term neonates under general anesthesia: A retrospective study

Abstract

Background: Oscillometric noninvasive blood pressure and/or invasive intra-arterial blood pressure are commonly used to measure the systolic, diastolic, and mean components of blood pressure. Agreement between the two methods has been reported in adults, children, and infants, but rarely in neonates, especially under general anesthesia. Aims: This retrospective study compared the agreement of each measured blood pressure value (oscillometric noninvasive or invasive intra-arterial blood pressure monitoring) in term neonates under general anesthesia. Methods: Data were collected from neonates born at ≥36 weeks of gestation whose body weight was ≥2500 g and who underwent abdominal or noncardiac thoracic surgery with both oscillometric noninvasive and invasive intra-arterial blood pressure measurements from January 2015 to March 2020. The primary outcome was the agreement of systolic, diastolic, and mean blood pressure values between the two methods using Bland-Altman analysis. Results: Paired blood pressure measurements (n = 1193) from 67 cases were compared. In Bland-Altman analysis, bias (standard deviation), 95% limits of agreement,

A prospective comparison of invasive and non‐invasive blood pressure in children undergoing cardiac catheterization

“…The largest study of anesthetized adults to date, using retrospective data, found significant differences in pressures measured invasively or non‐invasively 8 . Two studies of anesthetized children, published since commencement of the current study, report acceptable agreement in most cases; however, both studied a relatively small number of patients 9,10 …”

“…8 Two studies of anesthetized children, published since commencement of the current study, report acceptable agreement in most cases; however, both studied a relatively small number of patients. 9,10 The primary aim of this study was to assess the agreement for MAP measured invasively and by non-invasive oscillometry in anesthetized children. Secondary aims were to assess agreement: for SBP and DBP; at different ages and weights; and during periods of hypotension.…”

“…Two recent studies of anesthetized children reported acceptable agreement for mean arterial pressure: a retrospective analysis of 67 anesthetized term neonates by Fujii et al found a bias (SD) of 1.3(5.8) mmHg9 ; a prospective observational study by Meidert et al of 25 children aged under 3 years also showed reasonable agreement, with bias (SD) of 3 (7) mmHg, although agreement was poor during episodes of hypotension (bias −9 (5) mmHg) 10. …”

Arterial Monitoring in Hypertensive Emergencies: Significance for the Critical Care Resuscitation Unit

“…3,4 Previous studies have shown, however, that discrepancies exist between noninvasive CBP and invasive ABP measurement. [5][6][7][8][9][10][11][12] Accuracy of CBP measurement may be affected by obesity, cuff location, age, and arterial stiffness. [13][14][15][16] Accurate measurement of BP is important, as brief episodes of either hypotension or hypertension are associated with higher rates of mortality and other unfavorable outcomes in various critical illnesses.…”

After nectarine: how should we provide anesthesia for neonates?

“…Whether these ‘hard’ limits, based on ambulatory [17] or preanesthetic [18,19] references, are safe for each patient is unknown [20–23]. In addition, the accuracy of blood pressure measurements can differ between 15 and 30% depending on the methods used especially below 30 mmHg [16 ▪ ,24], further increasing the uncertainty. The lower limit of cerebral blood flow autoregulation under anesthetic conditions remains speculative [25].…”