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.
Highlights
Since the end of nineteenth century, when non-invasive monitoring using Riva-Rocci sphygmomanometer was improved and implemented into wide clinical praxis by Harvey Cushing, blood pressure (BP) became one of the three most important vital signs evaluated in the perioperative care
The American Society of Anesthesiologists (ASA) recommends in the Standards for basic anesthetic monitoring, that BP should be monitored in all anesthetized persons at least at 5-min intervals [1]
Salmasi et al [9] have demonstrated on a large database (57,315 non-cardiac surgery patients) that risk of acute kidney injury (AKI) and myocardial injury (MI) starts to increase when intraoperative BP declines below 65 mmHg or more than 20% from baseline
Summary
Since the end of nineteenth century, when non-invasive monitoring using Riva-Rocci sphygmomanometer was improved and implemented into wide clinical praxis by Harvey Cushing, blood pressure (BP) became one of the three most important vital signs evaluated in the perioperative care. In the retrospective analysis of 46,496 procedures performed on 30,650 patients in six American Veteran hospitals by Monk et al [16], IOH, but not hypertension, was coupled with increased 30-day mortality after major non-cardiac surgery Thresholds found in this were basically similar to Mascha et al [15]: absolute SAP < 67–70 mmHg or MAP < 49 mmHg for more than 5 min and relative MAP drop more than 50% of baseline for 5 min. Low pre-induction SAP, older age, and emergency surgery contributes to both types of IOH, but the use of supplementary epidural or spinal anesthesia, male sex, and the American Society of Anesthesiologists physical status grade 4 was associated with hypotension occurring later on during the procedure Another possibility is to use continuous BP monitoring which may help to identify hypotensive periods more swiftly and decrease the time dose [7]
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