Abstract

BackgroundRabbits are particularly sensitive to develop hypotension during sedation or anaesthesia. Values of systolic or mean non-invasive arterial blood pressure below 80 or 60 mmHg respectively are common under anaesthesia despite an ongoing surgery. A reliable method of monitoring arterial blood pressure is extremely important, although invasive technique is not always possible due to the anatomy and dimension of the artery. The aim of this study was to evaluate the agreement between a new oscillometric device for non-invasive arterial blood pressure measurement and the invasive method. Moreover the trending ability of the device, ability to identify changes in the same direction with the invasive methods, was evaluated as well as the sensibility of the device in identifying hypotension arbitrarily defined as invasive arterial blood pressure below 80 or 60 mmHg.ResultsBland-Altman analysis for repeated measurements showed a poor agreement between the two methods; the oscillometric device overestimated the invasive arterial blood pressure, particularly at high arterial pressure values. The same analysis repeated considering oscillometric measurement that match invasive mean pressure lower or equal to 60 mmHg showed a decrease in biases and limits of agreement between methods. The trending ability of the device, evaluated with both the 4-quadrant plot and the polar plot was poor. Concordance rate of mean arterial blood pressure was higher than systolic and diastolic pressure although inferior to 90%. The sensibility of the device in detecting hypotension defined as systolic or mean invasive arterial blood pressure lower than 80 or 60 mmHg was superior for mean oscillometric pressure rather than systolic. A sensitivity of 92% was achieved with an oscillometric measurement for mean pressure below 65 mmHg instead of 60 mmHg. Non-invasive systolic blood pressure is less sensitive as indicator of hypotension regardless of the cutoff limit considered.ConclusionsAlthough mean invasive arterial blood pressure is overestimated by the device, the sensitivity of this non-invasive oscillometric monitor in detecting invasive mean pressure below 60 mmHg is acceptable but a cutoff value of 65 mmHg needs to be used.

Highlights

  • Rabbits are sensitive to develop hypotension during sedation or anaesthesia

  • Considering the overall values invasive arterial blood pressure (IBP) was overestimated by the Non-invasive arterial blood pressure (NIBP) with a negative slope and a wide limits of agreement of approximately 50 mmHg for Mean arterial blood pressure (MAP) and Diastolic arterial blood pressure (DAP)

  • Repeating the analysis with pairs that included invasive Systolic arterial blood pressure (SAP) and MAP lower or equal to 80 and 60 mmHg respectively, resulted in a reduction of bias, standard deviation and limit of agreements compare to the previous analysis only for the mean arterial pressure (Fig. 1b and d)

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Summary

Introduction

Rabbits are sensitive to develop hypotension during sedation or anaesthesia. The trending ability of the device, ability to identify changes in the same direction with the invasive methods, was evaluated as well as the sensibility of the device in identifying hypotension arbitrarily defined as invasive arterial blood pressure below 80 or 60 mmHg. Anaesthesia related mortality at 48 h post-procedure is higher in rabbits than in dogs and cats [1]. Direct invasive arterial blood pressure (IBP) measurement is considered the “gold standard” for arterial blood pressure measurement. This technique requires an arterial catheterization that may be technically difficult in small animals and it may lead to blood extravasation with haematoma and risk of ear necrosis [5]. Non-invasive arterial blood pressure (NIBP) measurement methods may overcome some of these limitations and the agreement between these methods has been evaluated

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