Continuous Non-Invasive Arterial Pressure Assessment during Surgery to Improve Outcome

Abstract

Blood pressure (BP) is one of the most important variables evaluated during almost every medical examination. Most national anesthesiology societies recommend BP monitoring at least once every 5 min in anesthetized subjects undergoing surgical procedures. In most cases, BP is monitored non-invasively using oscillometric cuffs. Although the risk of arterial cannulation is not very high, the invasive BP monitoring is usually indicated only in the case of high-risk patients or in complex surgical procedures. However, recent evidence points out that when using intermittent BP monitoring short periods of hypotension may be overlooked. In addition, large datasets have demonstrated that even short periods of low BP (or their cumulative duration) may have a detrimental impact on the development of postoperative outcome including increased risk of acute kidney or myocardial injury development. Recently marketed continuous non-invasive blood pressure monitoring tools may help us to recognize the BP fluctuation without the associated burden of arterial cannulation filling the gap between intermittent non-invasive cuff and continuous invasive arterial pressure. Among others, several novel devices based either on volume clamp/vascular unloading method or on applanation tonometry are nowadays available. Moreover, several near-future smart technologies may lead to better hypotension recognition or even prediction potentially improving our ability to maintain BP stability throughout the anesthesia or surgical procedure. In this review, novel or emerging technologies of non-invasive continuous blood pressure assessment and their potential to improve postoperative outcome are discussed.

Measurement of Blood Pressure by Ultrasound—The Applicability of Devices, Algorithms and a View in Local Hemodynamics

“…The CNAP system provides BP data with “acceptable” [ 39 , 40 ], “comparable” [ 41 ] and “clinical useful” [ 42 , 43 ] precision and accuracy, as well as with a “larger discrepancy than defined as acceptable” [ 44 ] when compared to NIBP and invasive BP measurement. In addition, there is a “lack of evidence” of accuracy in CNAP’s BP data [ 45 ].…”

Detection of hypotension during spinal anesthesia for caesarean section with continuous non-invasive arterial pressure monitoring and intermittent oscillometric blood pressure monitoring in patients treated with ephedrine or phenylephrine

“…Majority of the studies use the drop of 20% of baseline BP, or use the value of systolic BP below 100 mmHg as hypotension [17]. Besides the hypotension definition, type of monitoring also may impact on efficiency of hypotension detection and thus its prevention and treatment [10,18,19]. Stenglova and Benes [19] reviewed and emphasized that even a short period of hypotension, especially if they are more frequent, may significantly influence on postoperative recovery.…”

“…The sample size was determined by Altman nomogram and confirmed by calculation with the formula was defined with a total of 76 patients. The data collected were processed in SPSS v. 19.0 (IBM Corp., Armonk, NY, USA) software. For statistical analysis we used Kolmogorov-Smirnov normality test, then parametric and non-parametric Student's t-test, Mann-Whitney, Pearson's correlational test, χ² test, and Fisher's exact test for analysis of frequency distribution; p values < 0.05 were considered as significant.…”

Efficacy of goal-directed fluid therapy monitored by pulse-pressure variation using a continuous noninvasive arterial pressure monitoring system (the CNAPTM system) during parathyroidectomy in patients with end-stage renal failure – a randomised trial

“…Important variations in blood pressure are common during parathyroidectomy [8], possibly leading to cardiac and kidney injury [34], which is of particular concern in patients with end-stage kidney failure. The use of traditional noninvasive blood pressure monitoring using a cuff might cause a delay in detecting blood pressure fluctuations and impair the quick response needed to avert injury; in addition, short periods of hypotension could be overlooked [34]. To achieve and maintain dry weight, the use of noninvasive haemodynamic monitoring, such as with the use of a CNAP monitoring system to monitor the water load in haemodialysis, has been advocated [35].…”