open access

Vol 50, No 4 (2018)
Original and clinical articles
Published online: 2018-10-30
Submitted: 2018-05-15
Accepted: 2018-09-30
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Inter-arm differences in blood pressure among subjects with disseminated atherosclerosis scheduled for vascular surgery

Dariusz Gajniak, Konrad Mendrala, Danuta Gierek, Łukasz J. Krzych
DOI: 10.5603/AIT.2018.0039
·
Pubmed: 30378093
·
Anaesthesiol Intensive Ther 2018;50(4):291-296.

open access

Vol 50, No 4 (2018)
Original and clinical articles
Published online: 2018-10-30
Submitted: 2018-05-15
Accepted: 2018-09-30

Abstract

Background: The measurement of blood pressure (BP) is routinely performed in perioperative care. The reliability of results is essential for the implementation of treatment ensuring haemodynamic stability. The aim of the present study was to assess the prevalence and basic determinants of inter-arm BP differences among patients with advanced peripheral atherosclerosis undergoing vascular surgical procedures of the lower limbs. Methods: The prospective study was carried out in patients scheduled for elective lower limb vascular surgery. One-time non-invasive BP measurements were performed sequentially on the brachial arteries of both upper extremities before the induction of anaesthesia, maintaining the shortest possible interval between measurements. The systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were recorded. Results: The results of 173 patients (including 123 men aged 67 ± 8 years) were analysed. In 16 (9.3%) patients, an inter-arm difference in BP was already observed during the preoperative examination. SBP and DBP was higher in the right limb in 86 (49.7%) an 80 (46.3%) patients, respectively. Moreover, the medians of inter-arm differences in SBP, DBP and MAP were 9 (IQR 4–17), 5 (IQR 3–10) and 7 mm Hg (IQR 3–12), respectively. An evaluation of the determinants of BP differences related to the presence of additional diseases demonstrated that patients with arterial hypertension were characterised by higher SBP and MAP disproportions (P = 0.04 and P = 0.01). Conclusions: In the population of patients with disseminated atherosclerosis, the inter-arm differences in BP substantially exceed the measurement error limits and are likely to be associated with arterial hypertension. If in doubt about BP disproportions, intraoperative monitoring of BP should be recommended using an invasive method on the limb presenting higher non-invasively measured values.

Abstract

Background: The measurement of blood pressure (BP) is routinely performed in perioperative care. The reliability of results is essential for the implementation of treatment ensuring haemodynamic stability. The aim of the present study was to assess the prevalence and basic determinants of inter-arm BP differences among patients with advanced peripheral atherosclerosis undergoing vascular surgical procedures of the lower limbs. Methods: The prospective study was carried out in patients scheduled for elective lower limb vascular surgery. One-time non-invasive BP measurements were performed sequentially on the brachial arteries of both upper extremities before the induction of anaesthesia, maintaining the shortest possible interval between measurements. The systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were recorded. Results: The results of 173 patients (including 123 men aged 67 ± 8 years) were analysed. In 16 (9.3%) patients, an inter-arm difference in BP was already observed during the preoperative examination. SBP and DBP was higher in the right limb in 86 (49.7%) an 80 (46.3%) patients, respectively. Moreover, the medians of inter-arm differences in SBP, DBP and MAP were 9 (IQR 4–17), 5 (IQR 3–10) and 7 mm Hg (IQR 3–12), respectively. An evaluation of the determinants of BP differences related to the presence of additional diseases demonstrated that patients with arterial hypertension were characterised by higher SBP and MAP disproportions (P = 0.04 and P = 0.01). Conclusions: In the population of patients with disseminated atherosclerosis, the inter-arm differences in BP substantially exceed the measurement error limits and are likely to be associated with arterial hypertension. If in doubt about BP disproportions, intraoperative monitoring of BP should be recommended using an invasive method on the limb presenting higher non-invasively measured values.

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Keywords

perioperative care, vascular surgery, blood pressure, measurements, atherosclerosis

About this article
Title

Inter-arm differences in blood pressure among subjects with disseminated atherosclerosis scheduled for vascular surgery

Journal

Anaesthesiology Intensive Therapy

Issue

Vol 50, No 4 (2018)

Pages

291-296

Published online

2018-10-30

DOI

10.5603/AIT.2018.0039

Pubmed

30378093

Bibliographic record

Anaesthesiol Intensive Ther 2018;50(4):291-296.

Keywords

perioperative care
vascular surgery
blood pressure
measurements
atherosclerosis

Authors

Dariusz Gajniak
Konrad Mendrala
Danuta Gierek
Łukasz J. Krzych

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