Cuff Width Research Articles

Disagreement of the two oscillometric blood pressure measurement devices, Datascope Accutorr Plus and Omron HEM-705CP II, and bidirectional conversion of blood pressure values

Oscillometric blood pressure (BP) measurement devices frequently replace the standard mercury sphygmomanometer. Comparisons of oscillometric devices are rare, but their agreement is important to ensure comparability of BP data. This study aims to compare two oscillometric devices, Datascope Accutorr Plus and Omron HEM-705CP II, and to develop BP conversion models. A sample of 109 adults aged 21-64 years were subjected to alternate same-arm BP measurements according to the International Protocol revision 2010 for the validation of BP measuring devices in adults of the European Society of Hypertension. A total of 327 BP measurement pairs were obtained. Datascope systolic blood pressure (SBP) pairs, in mmHg, were optimal (<120) for n=188, prehypertensive (120-139) for n=107, and hypertensive (≥140) for n=32 [diastolic blood pressure (DBP)<80 (n=261)/80-89 (n=57)/≥90 (n=9)]. The mean Omron values were higher and the difference increased with BP [mean differences, Omron minus Datascope, within BP ranges were (in mmHg): SBP 1.1±4.7, 3.0±5.5, and 9.3±6.7 and DBP 0.2±3.3, 2.3±3.4, and 5.1±3.9] and pulse pressure (>50 mmHg, SBP difference 5.6±6.3). The prevalence of hypertensive BP was 11% with Omron and 5% with Datascope. Bidirectional conversion models of SBP and DBP values include BP, pulse pressure, age, sex, and the difference in the ratio of cuff width to arm circumference. The disagreement in oscillometric devices can reach a magnitude that could be of interest for clinical and epidemiological contexts. Conversion formulas with BP, pulse pressure, sex, age, and the cuff width to arm circumference ratio may help to improve comparability.

Adolescent hypertension identified with correct cuff and its cardiovascular and gestational problems after 29 years

Objective to identify, in 2011, rates of hypertension, cardiovascular and gestational problems in subjects presenting high blood pressure in 1982, when correct cuff size was used, according to the American Heart Association Arm Circumference/Cuff Width ratio of 0.40. Methods high blood pressure was defined in 2011 as systolic = 115 mmHg and diastolic = 80mmHg, resulting in 20 subjects between 39 and 43 years old. (Risk Group). They were compared to 20 subjects from the original sample with lower blood pressure values (Control group). Results the rates of hypertension, cardiovascular and gestational problems were significantly higher (Fisher: p=0.02) in the Risk Group, with one case of cardiovascular death. Our findings arouse speculations about whether, if a proper cuff had been used in clinical practice, the complications and death could have been avoided. Conclusions data suggest compliance with the use of cuff width corresponding to 40% of arm circumference, despite polemics concerning cuff availability and difficulties of using many sizes.

수술 전 검사 시기에 따른 자기공명영상과 관절경상의 회전근 개 파열의 크기 비교

Purpose: To know if magnetic resonance image (MRI) re-examination is needed before surgery, we compared the pre-operative MRI recorded at different time points and the corresponding arthroscopic findings. Materials and Methods: Depending on the timing of evaluation, the MRI was classified into three groups: group A, MRI was taken 1 month before the surgery (44 cases, average 16 days); group B, 1-6 months before the surgery (41 cases, average 91 days); and group C, 6-12 months before the surgery (25 cases, average 230 days). The anterior to posterior tear size (length) and medial retraction size (width) of rotator cuff tear were measured for each group and they were compared with the actual arthroscopic findings. Results: Results of this study showed that arthroscopic rotator cuff tear length and width were larger than those of MRI. The difference of the rotator cuff tear size was 3.6(±1.2) ㎜ of length and 0.6(±0.4) ㎜ of width in group A, 4.2(±1.7) ㎜ and 2.4(±1.1) ㎜ in group B, and 4.5(±2.1) ㎜ and 3.0(±1.5) ㎜ in group C. There was a tendency of the larger size difference for longer pre-operative period, but it was not statistically significant. Conclusion: The rotator cuff tear size did not show remarkable differences between pre-operative MRI taken within 1 year before surgery and the actual arthroscopy. It is concluded that additional MRI evaluation is not required within 1 year.

Putting Evidence Into Nursing Practice: Four Traditional Practices Not Supported by the Evidence

Evidence-based nursing practice is essential to the delivery of high-quality care that optimizes patients' outcomes. Studies continue to show improved outcomes when best evidence is used in the delivery of patient care. Despite awareness of the importance of practicing by using best evidence, achieving and sustaining evidence-based practice within practice environments can be challenging, and research suggests that integration of evidence-based practice into daily clinical practice remains inconsistent. This article addresses 4 practice issues that, first, are within the realm of nursing and if changed might improve care of patients and, second, are areas in which the tradition and the evidence do not agree and practice continues to follow tradition. The topics addressed are (1) noninvasive measurement of blood pressure in children, (2) oxygen administration for patients with chronic obstructive pulmonary disease, (3) intravenous catheter size and blood administration, and (4) infection control practices to prevent infections. The related beliefs, current evidence, and recommendations for practice related to each topic are described.

Equipment errors: a prevalent cause for fallacy in blood pressure recording - a point prevalence estimate from an Indian health university.

Background:Blood pressure (BP) recording is the most commonly measured clinical parameter. Standing mercury sphygmomanometer is the most widely used equipment to record this. However, recording by sphygmomanometer is subject to observer and instrumental error. The different sources of equipment error are faulty manometer tube calibration, baseline deviations and improper arm bladder cuff dimensions. This is further compounded by a high prevalence of arm bladder miss-cuffing in the target population.Objectives:The study was designed to assess the presence of equipment malcalibrations, cuff miss-matching and their effect on BP recording.Materials and Methods:A cross-sectional check of all operational sphygmomanometers in a health university was carried out for the length of the manometer tube, deviation of resting mercury column from “0” level, the width and length of arm bladder cuff and extent of bladder cuff-mismatch with respect to outpatient attending population.Results:From the total of 50 apparatus selected, 39 (78%) were from hospital setups and 11 (22%) from pre-clinical departments. A manometer height deficit of 13 mm was recorded in 36 (92.23%) of the equipment in hospital and 11 (100%) from pre-clinical departments. Instruments from both settings showed significant deviation from recommended dimensions in cuff bladder length, width and length to width ratio (P < 0.001). Significant number of apparatus from hospital setups showed presence of mercury manometer baseline deviation either below or above 0 mmHg at the resting state (χ2 = 5.61, D. F. = 1, P = 0.02). Positive corelationship was observed between manometer height deficit, baseline deviation and width of arm cuff bladder (Pearson correlation, P < 0.05). Bladder cuff mismatching in response to the target population was found at 48.52% for males and 36.76% for females. The cumulative effect of these factors can lead to an error in the range of 10-12 mmHg.Conclusion:Faulty equipments and prevalent arm bladder cuff-mismatching can be important barriers to accurate BP measurement.

Blood flow-restricted exercise in space

Prolonged exposure to microgravity results in chronic physiological adaptations including skeletal muscle atrophy, cardiovascular deconditioning, and bone demineralization. To attenuate the negative consequences of weightlessness during spaceflight missions, crewmembers perform moderate- to high-load resistance exercise in conjunction with aerobic (cycle and treadmill) exercise. Recent evidence from ground-based studies suggests that low-load blood flow-restricted (BFR) resistance exercise training can increase skeletal muscle size, strength, and endurance when performed in a variety of ambulatory populations. This training methodology couples a remarkably low exercise training load (approximately 20%–50% one repetition maximum (1RM)) with an inflated external cuff (width, ranging between approximately 30–90 mm; pressure, ranging between approximately 100–250 mmHg) that is placed around the exercising limb. BFR aerobic (walking and cycling) exercise training methods have also recently emerged in an attempt to enhance cardiovascular endurance and functional task performance while incorporating minimal exercise intensity. Although both forms of BFR exercise training have direct implications for individuals with sarcopenia and dynapenia, the application of BFR exercise training during exposure to microgravity to prevent deconditioning remains controversial. The aim of this review is to present an overview of BFR exercise training and discuss the potential usefulness of this method as an adjunct exercise countermeasure during prolonged spaceflight. The work will specifically emphasize ambulatory BFR exercise training adaptations, mechanisms, and safety and will provide directions for future research.

Cuff Width Increases the Serum Biochemical Markers of Tourniquet-induced Skeletal Muscle Ischemia in Rabbits

Tourniquet application is a widely accepted adjuvant technique in extremity surgery. The purpose of this prospective, randomized trial was to evaluate the effect of cuff width on skeletal muscle ischemia-reperfusion injury. A 2- or 4-cm wide curved tourniquet cuff was applied around the midthigh of 36 New Zealand White rabbits and inflated to a pressure of 200 or 400 mm Hg for 2 hours: group A=2 cm to 200 mm Hg; group B=2 cm to 400 mm Hg; group C=4 cm to 200 mm Hg; group D=4 cm to 400 mm Hg. Blood levels of potassium, lactic acid, urea, lactic dehydrogenase, and creatinine phosphokinase MM isoenzyme (CPK-MM) were measured as basic indicators for limb ischemia before tourniquet inflation and 1, 5, and 30 minutes after cuff release.Potassium values did not differ among the 4 groups. Lactic acid and urea concentrations were always higher in the 400 mm Hg groups (B and D) (P<.001). However, cuff width did not affect their levels (P>.16). Lactic dehydrogenase and CPK-MM values were also greater in the 400 mm Hg groups at all times (P<.001). Further subgroup analysis of 200 mm Hg pressure groups showed higher lactic dehydrogenase (P<.02) but not CPK-MM (P>.9) concentrations in group C than in group A during the 30-minute period. At 400 mm Hg, lactic dehydrogenase and CPK-MM values were higher in group D compared with group B only 30 minutes after cuff deflation (P<.001). Broad tourniquets are associated with significantly greater and prolonged elevation of serum biochemical markers of inducible skeletal muscle ischemia-reperfusion injury compared with narrow ones. This difference is more prominent when a wide cuff is inflated to a high pressure.

Comparison of direct and Doppler arterial blood pressure measurements in rabbits during isoflurane anaesthesia

ObjectiveTo measure the level of agreement between Doppler measured (DOP) arterial blood pressure (ABP) in the forelimb and directly measured (DIR) auricular systolic ABP (SAP) and mean ABP (MAP) in isoflurane-anaesthetized rabbits. Study designProspective clinical study. AnimalsData were analysed from 17 of 24 healthy rabbits, weighing 1.3–2.8 kg. MethodsRabbits were anaesthetized for neutering using a standardized protocol. A 26G catheter placed in an auricular artery was connected via heparinised saline filled non-compliant tubing (regularly flushed) to a calibrated pressure transducer (zeroed level with the thoracic inlet) to obtain DIR ABP. A cuff was placed proximal to the carpus (approximately level with the thoracic inlet) and a Doppler transducer sited over the dorsal carpal branch of the radial artery to obtain DOP ABP. Simultaneous DIR and DOP ABP recordings were made every 5–10 minutes during anaesthesia. Agreement was assessed as described by Bland JM & Altman (2007). ResultsMean ± SD cuff width: limb circumference ratio was 0.50 ± 0.04. Mean between-method differences ± SD, DIR SAP- DOP and DIR MAP- DOP, were +1 ± 8 and −13 ± 8 mmHg respectively. The 95% limits of agreement between DIR SAP and DOP and between DIR MAP and DOP were −14 to +17 and −28 to +2 mmHg respectively. Differences between DIR SAP and DOP were ≤10 mmHg 85% of the time. Defining hypotension as either DIR SAP < 80 mmHg or DIR MAP < 60 mmHg, and taking DOP ABP of <80 mmHg to indicate hypotension, sensitivity and specificity were 92% and 67% respectively. ConclusionsGood agreement was found between DIR SAP and DOP. Doppler measurements below 80 mmHg are a reliable indicator of arterial hypotension. Clinical relevanceDOP is acceptable for monitoring ABP in isoflurane-anaesthetized rabbits and is useful for detection of hypotension.

Effects of cuff width on arterial occlusion: implications for blood flow restricted exercise

The purpose of this study was to determine the difference in cuff pressure which occludes arterial blood flow for two different types of cuffs which are commonly used in blood flow restriction (BFR) research. Another purpose of the study was to determine what factors (i.e., leg size, blood pressure, and limb composition) should be accounted for when prescribing the restriction cuff pressure for this technique. One hundred and sixteen (53 males, 63 females) subjects visited the laboratory for one session of testing. Mid-thigh muscle (mCSA) and fat (fCSA) cross-sectional area of the right thigh were assessed using peripheral quantitative computed tomography. Following the mid-thigh scan, measurements of leg circumference, ankle brachial index, and brachial blood pressure were obtained. Finally, in a randomized order, arterial occlusion pressure was determined using both narrow and wide restriction cuffs applied to the most proximal portion of each leg. Significant differences were observed between cuff type and arterial occlusion (narrow: 235 (42)mmHg vs. wide: 144 (17)mmHg; p=0.001, Cohen's D=2.52). Thigh circumference or mCSA/fCSA with ankle blood pressure, and diastolic blood pressure, explained the most variance in the cuff pressure required to occlude arterial flow. Wide BFR cuffs restrict arterial blood flow at a lower pressure than narrow BFR cuffs, suggesting that future studies account for the width of the cuff used. In addition, we have outlined models which indicate that restrictive cuff pressures should be largely based on thigh circumference and not on pressures previously used in the literature.

Tourniquet use in upper limb surgery.

Tourniquets are compressive devices that occlude venous and arterial blood flow to limbs and are commonly used in upper limb surgery. With the potential risk of complications, there is some debate as to whether tourniquets should continue to be routinely used. In this review, we first look at the different designs, principles, and practical considerations associated with the use of tourniquets in the upper limb. The modern pneumatic tourniquet has many design features that enhance its safety profile. Current literature suggests that the risk of tourniquet-related complications can be significantly reduced by selecting cuff inflation pressures based on the limb occlusion pressure, and by a better understanding of the actual level of pressure within the soft tissue, and the effects of cuff width and contour. The evidence behind tourniquet time, placement, and limb exsanguination is also discussed as well as special considerations in patients with diabetes mellitus, hypertension, vascular calcification, sickle cell disease and obesity. We also provide an evidence-based review of the variety of local and systemic complications that may arise from the use of upper limb tourniquets including pain, leakage, and nerve, muscle, and skin injuries. The evidence in the literature suggests that upper limb tourniquets are beneficial in promoting optimum surgical conditions and modern tourniquet use is associated with a low rate of adverse events. With the improvement in knowledge and technology, the incidence of adverse events should continue to decrease. We recommend the use of tourniquets in upper limb surgery where no contraindications exist.

Inaccuracies introduced by single width blood pressure cuffs

Blood pressure cuff dimensions directly affect accuracy of blood pressure measurements. For accurate blood pressure measurements, the width of the cuff must be proportional to arm circumference. A cuff that is too narrow results in falsely high blood pressure values, and a cuff that is too wide results in falsely low values. Some blood pressure standards permit a single width cuff regardless of arm circumference. The purpose of this study was to evaluate whether 12 cm single width cuffs currently permitted by the British Hypertension Society (BHS) standard are sufficiently accurate to pass the Association for the Advancement of Medical Instrumentation (AAMI), BHS, and European Society of Hypertension (ESH) International Protocol (IP1) Working Group standards for accuracy. Each of 101 subjects was tested sequentially with both a single and a proportional width cuff in random order. Auscultatory blood pressure was determined by 2 observers using a double binaural stethoscope. Accuracy was determined by comparing the resulting differences with the AAMI, BHS, and IP1 standards for accuracy. The single width blood pressure cuff failed the AAMI accuracy standards for both systolic blood pressure on large arms and diastolic blood pressure on small and large arms, and overall. The single width cuffs, also, failed the BHS accuracy standards for diastolic BP. In conclusion, these single width cuffs could result in a significant number of people being misdiagnosed and mistreated for hypertension. Therefore, to avoid 'cuff hypertension' and 'cuff hypotension', the cuff width should be proportional to arm circumference.

上肢末梢皮膚血流量に及ぼす圧迫強度と圧迫帯幅の影響-レーザー・ドップラー法による検討-

上肢末梢皮膚血流量に及ぼす圧迫強度と圧迫帯幅の影響-レーザー・ドップラー法による検討-

Cuff width alters the amplitude envelope of wrist cuff pressure pulse waveforms

The accuracy of noninvasive blood pressure (BP) measurement with any method is affected by cuff width. Measurement with a too narrow cuff overestimates BP and measurement with a too wide cuff underestimates BP. Automatic wrist cuff BP monitors use permanently attached narrow cuffs with bladders about 6 cm wide. Such narrow cuffs should result in under-cuffing for wrist circumferences larger than 15 cm. The objective of this qualitative study was to show that a narrow wrist cuff results in increased BP values when a cuff pulse amplitude ratio algorithm is used. According to the algorithm used in this study, systolic pressure (SBP) corresponds to the point of 50% of maximal amplitude; for diastolic pressure (DBP) the ratio is 70%. Data were acquired from 12 volunteers in the sitting position. The mean wrist circumference was 18 cm. The acquired cuff pulse data were used to compute SBP, mean pressure (MAP) and DBP. The mean values for a 6 cm cuff were SBP = 144 mmHg, MAP = 104 mmHg and DBP = 88 mmHg. The values for a 10 cm cuff were SBP = 128 mmHg, MAP = 93 mmHg and DBP = 78 mmHg. The reference BP values were SBP = 132 mmHg, MAP = 96 mmHg and DBP = 80 mmHg. All narrow (6 cm) cuff BP values were higher than wide (10 cm) cuff or reference BP values. The results indicate that wider wrist cuffs may be desirable for more accurate and reliable BP measurement with wrist monitors.

Inaccuracies introduced by single width blood pressure cuffs

Blood pressure (BP) cuff dimensions directly affects accuracy of BP measurements. For accurate BP measurements the width of the cuff must be proportional to arm circumference. A cuff that is too narrow results in falsely high BP values, and a cuff that is too wide results in falsely low values. Some BP standards permit a single cuff regardless of arm circumference.The purpose of this study was to evaluate whether 12 cm single width cuffs currently permitted by the British Hypertension Society (BHS) standard are sufficiently accurate.Each of 101 subjects was tested sequentially with both a single and a proportional width cuff in random order. Auscultatory BP was determined by 2 observers using a double binaural stethoscope.The single width cuff BP failed the Association for the Advancement of Medical Instrumentation and BHS standards for clinically acceptable accuracy. The magnitude of failures ranged from a mean of 6.6 to 11.3 mmHg.In conclusion, this could result in a significant number of people being misdiagnosed and mistreated for hypertension. Therefore, to avoid “cuff hypertension” and “cuff hypotension”, the cuff width should be proportional to arm circumference.

Variation of Arterial Blood Pressure in Clinically Healthy and Conscious Cats Measured by Oscillometric Method

The purpose of this study was to assess the variation of arterial blood pressure depending on site of measurement, age, gender and body condition, respectively. The study was carried out on 67 outpatient healthy cats, age between 1 and 14 years, of different breeds. The blood pressure was measured using oscillometric blood pressure monitor, that was previously validated for use in dog and cats. This automatic oscillometric device indirectly measures systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and pulse frequency. For each cat, a cuff width of between 30-40% of the measurement site was chosen and the systemic blood pressure value was calculated as the mean of five readings, with interval of 20 to 30 seconds between consecutive readings. In a subgroup of 46 cats was evaluated the arterial blood pressure measured, for each cat, both at the base of the tail and the thoracic limb.

Uso de dispositivo automático de medida de pressão arterial em crianças entre 4 e 13 anos

Estudo realizado para averiguar a confiabilidade de valores obtidos na aferição de pressão arterial em crianças com um aparelho automático de medida de pressão arterial. Tem como objetivos verificar os valores de pressão nas artérias braquial e radial de crianças pelo método auscultatório com o manguito de largura correta e compará-los aos valores obtidos nas mesmas artérias com instrumento automático. A pesquisa foi realizada com crianças atendidas em um hospital universitário do interior do estado de São Paulo. Utilizou-se o monitor digital de pressão arterial de pulso Tech Line WS-501. A amostra, de 100 crianças, compôs-se de crianças cuja circunferência do braço ou punho estava entre 14 e 17 cm, adequadas ao uso do manguito de 6 cm de largura. O aparelho foi utilizado seguindo suas especificações. Os valores da pressão arterial sistólica obtidos com o aparelho automático foram superiores à coluna de mercúrio em 1,38 mmHg, em média. Em relação à pressão arterial diastólica, os valores obtidos com o aparelho de mercúrio foram superiores ao aparelho digital em 1,22 mmHg, em média. Assim, o aparelho Tech Line WS-501 mostrou-se adequado para o uso clínico, desde que a circunferência destes membros esteja de acordo com as especificações do aparelho automático.

Blood pressure measurement: arm circumference and cuff size availability

To avoid inaccurate blood pressure (BP) readings, the American Heart Association (AHA) recommends cuff width (CW) encircling 40% of the arm circumference (AC) and cuff length at least 80-100%. This study aimed to identify inpatients AC, the corresponding cuff size and the cuff size availability. In total, 81 AC were measured in the right arm. The cuff sizes to fit them were calculated according to AHA AC/CW width 0.40 ratio. The AC varied from 17.5 to 40.5 cm and the corresponding cuff width from 6 to 16 cm. The standard cuff 12 by 23 cm, the only size available in the clinics, was appropriate for only 17.3% of the subjects, whose AC varied between 32.5 and 34.3 cm. The lack of availability of different cuff sizes continues being a challenging problem to be faced. The standard cuff available, 12 cm large, did not fit 82.7% of the identified AC, resulting in over or underestimated BP registers.

Medida da pressão arterial no braço e antebraço em função do manguito

OBJETIVO: Identificar e comparar os níveis de pressão arterial no braço e antebraço usando manguitos de dimensões apropriadas e o manguito padrão. MÉTODOS: Estudo transversal com 103 indivíduos, aplicando a razão circunferência braquial (CB) /largura de manguito de 0,40 nos dois segmentos, e registros com o manguito padrão após um minuto. razão CB /comprimento do manguito de 0,80, correto ou padrão, circunferências medidas no ponto médio de cada segmento. RESULTADOS: Diferenças significativas indicaram hiperestimação da pressão diastólica no antebraço, menor daquela observada em outros estudos. A manobra de Forsberg melhorou a audibilidade dos sons de Korotkoff. CONCLUSÃO: Os achados indicam que o manguito correto diminui a hiperestimação dos registros diastólicos observada por outros autores. O avanço no conhecimento da medida no antebraço requer outros estudos.

Cuff dimension for children and adolescents: a study in a northeastern Brazilian city

The goal of this study was to measure the arm circumferences (AC) and appropriated cuff sizes for children and adolescents and to relate these dimensions to specific age ranges. This is a cross-sectional study, developed in Fortaleza, Ceará, Brazil, with 596 people between 6 and 17 years old. The AC was measured at the midpoint between the olecranon and the acromion. The selected cuff width followed the recommended ratio of 40% the AC. The more suitable cuff sizes were 7x14 cm, 8x16 cm and 9x18 cm, at 19.8%, 26.5% and 25%, respectively. A statistically significant association between AC and age range was found in both genders, as well as between the cuff and the age range, showing that the 7x14 cm (38.9%) and 8x16 cm (29.6%) cuffs were more suitable for children, and 8x16 cm (23.7%) and 9x18 cm (36.1 %) cuffs were better for adolescents. Adequate cuffs were concluded to be different from the standard cuffs used for children and adolescents.

Effect of different cuff widths on the motor nerve conduction of the median nerve: an experimental study

BackgroundA bloodless operative field is considered mandatory for most surgical procedures on the upper and lower extremity. This is accomplished by using either an Esmarch bandage or a pneumatic tourniquet, but a number of complications are associated with both. Nerve palsy is one of the most frequently encountered complications of this procedure. Wider cuffs have been found to cause reduced risk of tourniquet induced injury to the underlying soft tissues than the narrower ones due to the fact that lower occlusion pressures are caused by the former. To address and investigate this question, conduction in the median nerve has been measured proximal to tourniquet as well as distal to the tourniquet. Parameters of nerve conduction measured are nerve conduction velocity, latency and amplitude.MethodsSphygmomanometer cuffs with widths 14 cm and 7 cm were applied to the upper extremities of 20 healthy, normotensive volunteers (9 males and 11 females with age ranging from 22 to 27). Systolic blood pressure was measured first and then the cuff was inflated to about 20–30 mm Hg above it and was kept inflated for 15 minutes. Recordings were done prior to, for the period of tourniquet inflation, and following release of the tourniquet.ResultsNerve conduction was found to be more severely affected by the 14 cm cuff than the 7 cm cuff.ConclusionWider cuffs resulted in more severe changes in the nerve. This brings us to the conclusion that though lower inflation pressures are required for the occlusion of the blood supply using wider cuffs, the nerve conduction is more severely affected by the wider ones. Both electrophysiological changes and occlusion pressure should be kept in mind while choosing the width of the cuff.