Assessing the eligibility of a non-invasive continuous blood pressure measurement technique for application during total intravenous anaesthesia

2016 ◽  
Vol 61 (3) ◽  
pp. 369-379
Author(s):  
Robert Huhle ◽  
Joachim Siegert ◽  
Fred Wonka ◽  
Christoph Schindler ◽  
Marcelo Gama de Abreu ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Linear Trend ◽  
Blood Pressure Measurement ◽  
Patient Specific ◽  
Total Intravenous Anaesthesia ◽  
Data Set ◽  
Intravenous Anaesthesia ◽  
Non Invasive ◽  
Arterial Blood ◽  
Pressure Changes

Abstract Objective: To assess the eligibility for replacement of invasive blood pressure as measured “within” the arterial vessel (IBP) with non-invasive continuous arterial blood pressure (cNIP) monitoring during total intravenous anaesthesia (TIVA), the ability of cNiP to track fast blood pressure changes needs to be quantified. A new method of statistical data analysis is developed for this purpose. Methods: In a pilot study on patients undergoing neurosurgical anaesthesia, mean arterial pressure MAPIBP measured with IBP was compared to MAPCNP measured by the CNAP Monitor 500 in ten patients (age: 63±13 a). Correlation analysis of changes of device differences ΔeMAP=ΔMAPCNP-ΔMAPIBP with changes of MAPIBP (ΔMAPIBP) during intervals of vasoactivity was conducted. An innovative technique, of linear trend analysis (LTA) applied to two signals, is described to perform this analysis without a priori knowledge of intervals of vasoactivity. Results: Analysis of ΔeMAP during vasoactivity revealed that ΔMAPCNP systematically underestimated ΔMAPIBP by 37%. This was confirmed in the complete data set using LTA technique showing a systematic, yet patient specific, underestimation in tracking ΔMAPIBP (16…120%). Conclusion: The proposed LTA technique is able to detect systematic errors in tracking short-term blood pressure changes otherwise masked by established analysis. LTA may thus be a useful tool to assess the eligibility of cNIP to replace IBP during TIVA.

scholarly journals ARTERIAL HYPERTENSION-NON INVASIVE DIAGNOSIS

2006 ◽  
Vol 13 (01) ◽  
pp. 000-000
Author(s):  
MILAN ADAMEK
Keyword(s):  
Blood Pressure ◽  
Early Stage ◽  
Blood Pressure Measurement ◽  
Interventricular Septum ◽  
Recovery Period ◽  
Posterior Wall ◽  
Exercise Stress ◽  
Double Product ◽  
Non Invasive ◽  
Arterial Blood

Aims & Objectives: This study was designated to find andto characterize similarities andf differencies between two groups of patiens. One group were patients with establishedarterial hypertension / AH / and the second one were patients with new diagnosis of AH or who have so called highnormal blood pressure / BP / or who had randomly found elevated blood pressure once time in their history but,therefore they had normal BP on check examinations, they were left without treatment. The main goal of the study wasto show that the groups are similar in important parameters, which may be of clinical importance / decision abouttreatment / and to find which of the non invasive examinations, with exception of classical BP measurements, may stillplay the important role in setting the diagnosis of AH in early stage of the disease. And the second main goal of thestudy was to show that measurement of BP under basal conditions may sometimes be insufficient for decision makingif the patient is hypertonic or not. Methods: Following methods and measurements were used to obtain necessaryparameters – arterial blood pressure measurement, echocardiographic examination to obtain values as left ventriculardiameter in systole and diastole, interventricular septum and posterior wall thickness in systole and diastole, ejectionfraction - Teichholz, interventricular septum and posterior wall excursions, left atrial diameter, measurement of speedof aortic ejection, E/A index, isovolumic relaxation time, carotid myointimal thickening, carotid pulse velocity, time topeak of carotid upstroke and ambulatory blood pressure and electrocardiogram monitoring, measurement of bloodpressure reaction on exercise stress testing and in recovery period post exercise and double product.

Comparison of two injectable anaesthetic techniques on induction and subsequent anaesthesia in pigs

2021 ◽  
pp. 002367722110298
Author(s):  
Anneli Ryden ◽  
Sheila Fisichella ◽  
Gaetano Perchiazzi ◽  
Görel Nyman
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Anaesthetic Techniques ◽  
Total Intravenous Anaesthesia ◽  
Depth Of Anaesthesia ◽  
Intravenous Anaesthesia ◽  
Physiological Variables ◽  
Arterial Blood ◽  
Nociceptive Stimulus ◽  
Free Induction

Pig experiments often require anaesthesia, and a rapid stress-free induction is desired. Induction drugs may alter the subsequent anaesthesia. Therefore, the aim of the present study was to compare, in pigs, the effects of two different injectable anaesthetic techniques on the induction and on the physiological variables in a subsequent eight hours of total intravenous anaesthesia (TIVA). Twelve domestic castrates (Swedish Landrace/Yorkshire) 27‒31 kg were used. The pigs were randomly assigned to different induction drug combinations of zolazepam–tiletamine and medetomidine intramuscularly (ZTMe) or midazolam, ketamine intramuscularly and fentanyl intravenously (MiKF). Time from injection to unconsciousness was recorded and the ease of endotracheal intubation assessed. The TIVA infusion rate was adjusted according to the response exhibited from the nociceptive stimulus delivered by mechanically clamping the dewclaw. The time from injection to unconsciousness was briefer and intubation was easier in the ZTMe group. Results from the recorded heart rate, cardiac index and arterial blood pressure variables were satisfactorily preserved and cardiovascular function was maintained in both groups. Shivering was not observed in the ZTMe group, but was observed in four of the pigs in the MiKF group. The requirement of TIVA was lower in the ZTMe group. In conclusion, ZTMe had better results than MiKF in areas such as shorter induction time, better intubation scoring results and less adjustment and amount of TIVA required up to six hours of anaesthesia. The results may have been due to a greater depth of anaesthesia achieved with the ZTMe combination at the dose used.

scholarly journals A novel art of continuous non-invasive blood pressure measurement

2019 ◽  
Author(s):  
Jürgen Fortin ◽  
Dorothea Rogge ◽  
Christian Fellner ◽  
Doris Flotzinger ◽  
Julian Grond ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Blood Pressure Measurement ◽  
Wearable Sensors ◽  
Pulse Transit Time ◽  
Control Technique ◽  
Volume Control ◽  
Flow Monitoring ◽  
Non Invasive ◽  
Arterial Blood

AbstractWearable sensors to continuously measure blood pressure (BP) and derived cardiovascular variables have the potential to revolutionize patient monitoring. Current wearable methods analyzing time components (e.g., pulse transit time) still lack clinical accuracy, whereas existing technologies for direct BP measurement are too bulky. Here we present a new art of continuous non-invasive arterial blood pressure monitoring (CNAP2GO). It directly measures BP by using a new “volume control technique” and could be used for small wearable sensors integrated in a finger ring. As a software prototype, CNAP2GO showed excellent BP measurement performance in comparison with invasive BP in 46 patients having surgery. The resulting pulsatile BP signal carries information to derive cardiac output and other hemodynamic variables. We show that CNAP2GO can be miniaturized for wearable approaches. CNAP2GO potentially constitutes the breakthrough for wearable sensors for blood pressure and flow monitoring in both ambulatory and in-hospital clinical settings.

scholarly journals Tracking blood pressure changes by means of non-invasive intermittent blood pressure measurements in clinical application

2021 ◽  
Vol 7 (2) ◽  
pp. 815-818
Author(s):  
Robert Huhle ◽  
Thorsten Richter ◽  
Marcelo Gama de Abreu
Keyword(s):  
Blood Pressure ◽  
Arterial Blood Pressure ◽  
Pressure Range ◽  
Tracking Error ◽  
Correlation Coefficients ◽  
Non Invasive ◽  
Arterial Blood ◽  
The Mean ◽  
Blood Pressure Range ◽  
Pressure Changes

Abstract Considering accuracy/precision cut-offs of 5 ± 8 mmHg and cut-off values for inter-class correlation coefficients (ICC=0.37...1, from DIN EN ISO 81060-2), absolute and relative errors in time independent measurement of blood pressure changes with non-invasive intermittent devices (NiBP) are derived mathematically for mean arterial blood pressure range of 40-180 mmHg. As a clinically relevant value for change of arterial blood pressure 20% of the baseline blood pressure is considered. The mean ratio between the change of BP measured by the NiBP and measured by the invasive reference device (TE%) were proposed as quality measure for the evaluation of NiBP device tracking capability. The proposed measure TE%is theoretically independent of absolute accuracy but depends on precision and ICC of a device. NiBP devices show considerable maximum TE% of 41% in tracking mean blood pressure changes respectively. In 10% of the measurements in the low blood pressure range TE% exceeding 100%. The mean 50th/90th TE% percentile over the whole blood pressure range were 25/61%, respectively. Furthermore, TE% was relatively insensitive to assumed blood pressure range but sensitive to ICC. NiBP devices have high relative error in tracking blood pressure changes that make those devices not well-suited for tracking blood pressure changes. The proposed tracking error allows the definition of reasonable accuracy/precision requirements of NBP devices.

scholarly journals Comparison of Doppler ultrasonic and oscillometric devices (with or without proprietary optimisations) for non-invasive blood pressure measurement in conscious cats

2020 ◽  
pp. 1098612X2093240
Author(s):  
Petra Cerna ◽  
Panos E Archontakis ◽  
Hester OK Cheuk ◽  
Danièlle A Gunn-Moore
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Measurement ◽  
Reference Intervals ◽  
Invasive Blood Pressure ◽  
Non Invasive ◽  
Arterial Blood ◽  
Oscillometric Device ◽  
Significant Difference ◽  
Systolic Arterial Blood Pressure ◽  
The Mean

Objectives This study compared Doppler and oscillometric (PetMAP+) devices (with or without proprietary optimisations) for the non-invasive measurement of blood pressure in conscious cats. Methods Twenty-three cats were enrolled; however, five were excluded as fewer than five measurements were obtained for each assessment. All measurements were obtained according to American College of Veterinary Internal Medicine consensus guidelines. Oscillometric device modes A and B were operated according to the manufacturer’s guidelines. Doppler and oscillometric devices were used alternately as the first device. Results Systolic arterial blood pressure (SAP) measurements were obtained by Doppler (SAPd) and oscillometry; the mean of each set of five values was used for statistical analysis. There was a significant difference between SAPd and SAP measurements in oscillometric modes A ( P <0.001) and B ( P <0.001). While both modes measured SAP higher than SAPd, B had a smaller bias (+15.72 mmHg) and narrower limits of agreement (LOA). There was also a significant difference between SAPd and mean arterial pressure (MAP) on oscillometric modes A ( P = 0.002) and B ( P <0.001). Both modes’ MAP readings were lower than SAPd and oscillometric A MAP was closer to SAPd (–14.94 mmHg), with a smaller bias and narrower LOA. Conclusions and relevance The findings support that Doppler and oscillometric devices cannot be used interchangeably, with or without proprietary optimisations. Methodology should always be taken into account and reference intervals (RIs) need to be defined for the different methodologies. Until methodology-specific RIs are published, definitive diagnosis of hypertension and sub-staging of patients with kidney disease according to the International Renal Interest Society guidelines remains challenging.

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