Różnice ciśnienia tętniczego pomiędzy kończynami górnymi u chorych z zaawansowaną miażdżycą poddawanych naczyniowej interwencji chirurgicznej

Abstract

Background: The measurement of blood pressure (BP) is routinely performed in perioperative care. The reliability of results is essential for the implementation of treatment ensuring haemodynamic stability. The aim of the present study was to assess the prevalence and basic determinants of inter-arm BP differences among patients with advanced peripheral atherosclerosis undergoing vascular surgical procedures of the lower limbs. Methods: The prospective study was carried out in patients scheduled for elective lower limb vascular surgery. Onetime non-invasive BP measurements were performed sequentially on the brachial arteries of both upper extremities before the induction of anaesthesia, maintaining the shortest possible interval between measurements. The systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were recorded. Results: The results of 173 patients (including 123 men aged 67 ± 8 years) were analysed. In 16 (9.3%) patients, an inter-arm difference in BP was already observed during the preoperative examination. SBP and DBP was higher in the right limb in 86 (49.7%) an 80 (46.3%) patients, respectively. Moreover, the medians of inter-arm differences in SBP, DBP and MAP were 9 (IQR 4-17), 5 (IQR 3-10) and 7 mm Hg (IQR 3-12), respectively. An evaluation of the determinants of BP differences related to the presence of additional diseases demonstrated that patients with arterial hypertension were characterised by higher SBP and MAP disproportions (P = 0.04 and P = 0.01). Conclusions: In the population of patients with disseminated atherosclerosis, the inter-arm differences in BP substantially exceed the measurement error limits and are likely to be associated with arterial hypertension. If in doubt about BP disproportions, intraoperative monitoring of BP should be recommended using an invasive method on the limb presenting higher non-invasively measured values.

Intraoperative Blood Pressure Variability Predicts Postoperative Mortality in Non-Cardiac Surgery—A Prospective Observational Cohort Study

“…Thirdly, the first BP measurement was performed in the operating room before induction of anesthesia, which may impact the magnitude of BPV. Limitations come also from the non-invasive technique of BP monitoring, in which the correct measurement method is crucial to obtain reliable results [14,25]. However, this method is convergent with current recommendations for standards of monitoring during anesthesia [26].…”