An Algorithm for Assessing Intraoperative Mean Arterial Pressure Lability

Background Intraoperative blood pressure lability may be related to risk factors, hypovolemia, light anesthesia, and morbid outcomes, but the measurements of lability in previous studies have been limited by imprecise and infrequent data collection methods. Computerized intraoperative data acquisition systems have provided an opportunity to readdress the issue of intraoperative blood pressure lability with more abundant and precise data. This study sought to derive and validate an algorithm (expert system) to measure mean arterial pressure (MAP) lability. Methods Two hundred thirty-nine computerized anesthesis records were reviewed retrospectively. Three anesthesiologists separately rated MAP as very stable, average, or very labile. The parameters of a computer algorithm that measured the change of median MAP between consecutive 2-min epochs were optimized to achieve the best possible agreement among the anesthesiologists. The algorithm was then validated on 229 additional anesthesia records. Results The proportion of consecutive 2-min epochs in which the absolute value of the fractional change of median MAP exceeded 0.06 (i.e., 6%) correlated strongly with the anesthesiologists' ratings (r = 0.78; P < 0.0001). The optimal sensitivity and specificity of the algorithm for detecting MAP lability were 98% and 59%, respectively. Conclusions One potential application of expert systems to anesthesia practice is a "smart alarm" to detect blood pressure lability. It may also provide a better tool to assess the relation between lability and outcome than has been available previously.

Spectral analysis of arterial pressure lability in rats with sinoaortic deafferentation

Traditionally, the standard deviation (SD) of the mean arterial pressure (AP) has been used as an index for the AP lability produced by interruption of baroreceptor afferents. Although a useful measure of variance about the mean, the SD does not provide any information about the temporal characteristics of this variability. We employed two different spectral analytic techniques to characterize AP waveforms in rats with sinoaortic deafferentation (SAD) and in sham-operated (Sham) rats to determine if the AP waveform in SAD animals was qualitatively and/or quantitatively different from that of Sham animals. The SAD and Sham animals exhibited qualitatively different spectral profiles, suggesting that lability of AP in SAD animals is not simply an exaggeration of normal fluctuations. In addition, a low-frequency (0.3-0.5 Hz) spectral peak was found in Sham but not SAD animals, suggesting that it is associated with the baroreflex. Finally, we observed in both normal rats and rats without intact baroreceptors that the spectral components of AP are not static but rather vary continuously across time.