Impact of non invasive and beat-to-beat arterial pressure monitoring on intraoperative hemodynamic management

Abstract

The Nexfin device allows for non-invasive beat-to-beat blood pressure monitoring (BP_NXF). Perioperative hypotension and hypertension have been shown to be associated with poor clinical outcomes. The goal of the present study was to assess the ability of this device to decrease the duration of significant intraoperative hypo- or hypertension compared to standard BP monitoring by cuff (BP_CUFF). We studied25 patients (ASA I–III) undergoing either abdominal or orthopedic surgery. BP_CUFF was monitored every 5 min from the introduction of anesthesia, while BP_NXF was monitored continuously on the opposite arm. When systolic BP_NXF (SBP_NXF) decreased or increased more than 20% relative to baseline SBP_NXF, a standard BP_CUFF measurement was taken to compare values. In addition, the time interval between the 20% change in SBP_NXF and the next scheduled standard SBP_CUFF measurement was recorded for each event. The mean length of surgery was 3.0 ± 0.3 h. Patients presented with 11 ± 4 episodes of hypotension and 12 ± 4 episodes of hypertension during the surgery. If BP_CUFF had been used, this would have resulted in 21 ± 7 min of hypotension and 20 ± 10 min of hypertension. If hemodynamic changes seen by SBP_NXF were appropriately treated, an average of 7 ± 1 min/h of hypotension time, 7 ± 2 min/h of hypertension time and 14 ± 3 min per hour of hypo- or hypertension time may have been identified. The Nexfin BP has the potential to decrease the time of hypotension and hypertension compared to conventional intermittent BP_CUFF monitoring. Therefore, this device has the potential to positively impact clinical outcomes.