Cerebral Desaturation Events in the Beach Chair Position – Correlation of Non-Invasive Blood Pressure and Estimated Temporal Mean Arterial Pressure

2015 ◽  
Vol 24 (4) ◽  
pp. e117
Author(s):  
Jonathan C. Levy ◽  
Nathan Everding ◽  
Jacob J. Triplet ◽  
Christopher Lonetta ◽  
Molly Moor
Keyword(s):  
Blood Pressure ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Invasive Blood Pressure ◽  
Non Invasive ◽  
Beach Chair Position ◽  
Cerebral Desaturation ◽  
Beach Chair

scholarly journals Cerebral Oxygen Saturation Measured by Near-infrared Spectroscopy and Jugular Venous Bulb Oxygen Saturation during Arthroscopic Shoulder Surgery in Beach Chair Position under Sevoflurane-Nitrous Oxide or Propofol-Remifentanil Anesthesia

2012 ◽  
Vol 116 (5) ◽  
pp. 1047-1056 ◽  
Author(s):  
Hyejin Jeong ◽  
Seongtae Jeong ◽  
Hoi J. Lim ◽  
JongUn Lee ◽  
Kyung Y. Yoo
Keyword(s):  
Nitrous Oxide ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Oxygen Saturation ◽  
Cerebral Oxygenation ◽  
Shoulder Surgery ◽  
Tissue Oxygen Saturation ◽  
Beach Chair Position ◽  
Beach Chair ◽  
Jugular Venous Bulb

Background We examined the effects of different anesthetics on cerebral oxygenation and systemic hemodynamics in patients undergoing surgery in beach chair position (BCP). Jugular venous bulb oxygen saturation (SjvO2) and regional cerebral tissue oxygen saturation (SctO2) were determined while patients were placed from the supine to BCP. Whether SctO2 and SjvO2 are interchangeable in assessing the cerebral oxygenation was also examined. Methods Forty patients undergoing shoulder surgery in BCP were randomly assigned to receive sevoflurane-nitrous oxide (S/N) or propofol-remifentanil (P/R) anesthesia. Four patients taking angiotensin II receptor antagonists were excluded post hoc. Mean arterial pressure and heart rate, as well as SjvO2 and SctO2, were measured before (postinduction baseline in supine position) and after BCP. Results Mean arterial pressure decreased by BCP in both groups. It was, however, significantly higher in S/N (n = 19) than in P/R group (n = 17) at 7 to 8 min after the positioning. SjvO2 also significantly decreased after BCP in both groups, the magnitude of which was lower in S/N than in P/R group (11 ± 10% vs. 23 ± 9%, P = 0.0006). The incidences of SjvO2 <50% and mean arterial pressure less than 50 mmHg were lower in S/N group, but SctO2and the incidence of cerebral desaturation (more than 20% decrease from baseline) did not significantly differ between the groups. SctO2 and SjvO2 were only weakly correlated (β = 0.218, r2 = 0.133). Bland-Altman analysis showed a mean difference of -7.2% with 95% limit of agreement between -38.2% and 23.8%. Conclusions The margin of safety against impaired cerebral oxygenation is greater and SjvO2 is more preserved with S/N than with P/R anesthesia. SctO2 may not be reliable in detecting a low SjvO2 during the surgery in BCP.

Abstract 513: Impaired Hemodynamic Response to Head up Tilt in Adolescents Presenting with Chronic Nausea and Orthostatic Intolerance

Hypertension ◽  
2014 ◽  
Vol 64 (suppl_1) ◽  
Author(s):  
Hossam A Shaltout ◽  
Ashley L Wagoner ◽  
John E Fortunato ◽  
Debra I Diz
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Orthostatic Intolerance ◽  
Frequency Method ◽  
Non Invasive ◽  
Head Up Tilt ◽  
Blood Pressures ◽  
Chronic Nausea

We previously reported that ~70% of adolescents presenting to a Pediatric GI clinic for chronic nausea exhibit orthostatic intolerance (OI) in response to head upright tilt testing (HUT). The objective of this study was to determine whether supine mean arterial pressure or hemodynamic responses to HUT differ in these patients. Forty-eight patients (mean age of 15 [10-18] years, 36 females) completed a 45 minutes 0 to 70° HUT. Continuous blood pressure and heart rate recordings were acquired using non-invasive finger cuff. Thirteen subjects had normal tilt (Normal) while thirty five demonstrated OI. There were no differences between the two groups in supine blood pressures (BP), baroreflex sensitivity measured by frequency method in HF range (BRS), heart rate variability (HRV) measured as the root of mean square of successive differences (rMSSD), blood pressure variability (BPV) measured as standard deviation of mean arterial pressure (SDMAP) or the sympathovagal balance measure LF RRI /HF RRI . HUT caused a greater increase in heart rate in OI group (from 71 ± 6 beats/min to 104 ± 4 in OI vs from 75 ± 3 to 95 ±3 in normal, p=0.01) which was accompanied with lesser increase in BP (mainly due to lack of increase in diastolic) in the OI group. There was a trend for greater reduction in BRS in OI subjects (from 28.5 ± 13 ms/mm Hg to 6.3 ± 0.8 in OI vs from 21.1 ± 3.6 to 12.0 ± 2.9 in normal, p=0.09). HUT impaired HRV in both groups compared to supine values but the reduction was greater in OI group (-66.7 ± 4 % vs -52.0 ±5.6 in normal, p=<0.001). SDMAP increased by HUT compared to supine but to a greater extent in OI (40.6 ± 4 % vs 13.4 ± 8 in normal, p=0.02). LF RRI /HF RRI increased to a greater magnitude in OI group with HUT (from 1.8 ± 0.8 to 6.8 ± 0.8 in OI vs from 1.14 ± 0.18 to 4.1 ±0.7 in normal, p=0.02). These data reveal that the adolescents with orthostatic intolerance have attenuated parasympathetic responses and exaggerated activation of the sympathetic system to the heart and blood vessels. Despite these responses, subjects fail to maintain BP. Similar to previous studies in other subjects with OI, the excessive tachycardia often followed by syncope in most of these adolescents may reflect a loss of vascular responses to the activation of sympathetic and neurohumoral stimuli. Support: AHA12CRP9420029

Abstract NS 4: Non-Invasive Oscillometric Blood Pressure Monitoring in tPA Treated Patients: Is Mean Arterial Pressure Associated with Patient Outcomes?

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Anne W Alexandrov ◽  
Asad A Chaudhary ◽  
April Sisson ◽  
Kara Sands ◽  
Pawan Rawal ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Intracerebral Hemorrhage ◽  
Acute Stroke ◽  
National Standard ◽  
Stroke Patients ◽  
Non Invasive ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Stroke Center

Background: Blood pressure (BP) parameters for management of tPA treated patients are well known among experienced stroke clinicians, and violation of systolic and diastolic BP limits have previously been shown to be associated with symptomatic intracerebral hemorrhage (sICH) in tPA treated patients. Non-invasive oscillometric BP monitoring measures a “true” mean arterial pressure (MAP), and then algorithmically defines what systolic and diastolic pressure "might" be. Because this form of BP monitoring has become the national standard, we examined the occurrence of MAP BP elevations to determine their association with sICH and treatment outcome in acute ischemic stroke patients that received systemic tPA. Methods: Two-years of consecutive systemic tPA cases were retrieved from our Stroke Center database and arterial blood pressures for the first 24 hours from time of bolus were entered from auto-recordings in our electronic medical records. Protocol violations in MAP were defined as greater than 120 mm Hg at any point in the first 24 hours from time of bolus. Off-label treatment with intravenous tPA beyond 4.5 hours from symptom onset was identified a priori as a potential counfounder to stroke outcome. Symptomatic intracerebral hemorrhage was defined as an increase in the NIHSS of ≥ 4 points. Spearman’s correlation was used to assess the relationship between MAP and post-tPA NIHSS score. Results: 191 tPA cases were identified for inclusion in the analysis with 150 (79%) receiving their tPA at our Comprehensive Stroke Center and another 41 (21%) administered as a telephone-consult supported drip and ship. Patients were 65.5±16 years of age with median admission NIHSS scores of 12 (IQR=7-17). All patients had normal CT scans or minor changes consistent with acute stroke without hypo-attenuation. A total of 77 (40%) patients experienced a MAP violation overall. There were 11 isolated systolic BP violations, 4 isolated diastolic BP violations, and 21 isolated MAP violations that were otherwise not detectable by a violation in systolic or diastolic parameters, averaging 123.3±2 mm Hg. A total of 2 (1%) sICHs occurred in the sample, and of these 1 was associated with on-label peri-treatment BP protocol violations affecting systolic, diastolic and MAP parameters. An increased reduction in post-tPA NIHSS points was significantly associated with higher MAPs (r=.92; p=.008). Conclusions: Evidence-based guidelines are silent on MAP limits, and MAP is rarely monitored clinically in tPA treated patients despite dependence on the MAP for assignment of systolic and diastolic pressures in oscillometric BP monitoring. Our findings suggest that an improved understanding of the contribution of MAP-dependent oscillometric methods to BP monitoring in acute stroke patients is warranted.

scholarly journals Non-invasive continuous blood pressure monitoring (ClearSight™ system) during shoulder surgery in the beach chair position: a prospective self-controlled study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Konrad Chachula ◽  
Florian Lieb ◽  
Florian Hess ◽  
Joellen Welter ◽  
Nicole Graf ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Shoulder Surgery ◽  
Controlled Study ◽  
Pressure Monitoring ◽  
Non Invasive ◽  
Arterial Blood ◽  
Beach Chair Position ◽  
The Mean ◽  
Beach Chair

Abstract Background The beach chair position that is commonly used in shoulder surgery is associated with relative hypovolemia, which leads to a reduction in arterial blood pressure. The effects of patient positioning on the accuracy of non-invasive continuous blood pressure monitoring with the ClearSight™ system (CS-BP; Edwards Lifesciences, Irvine CA, USA) have not been studied extensively. Our research aim was to assess agreement levels between CS-BP measurements with traditional blood pressure monitoring techniques. Methods For this prospective self-controlled study, we included 20 consecutively treated adult patients undergoing elective shoulder surgery in the beach chair position. We performed Bland-Altman analyses to determine agreement levels between blood pressure values from CS-BP and standard non-invasive (NIBP) methods. Perioperative measurements were done in both the supine (as reference) and beach chair surgical positions. Additionally, we compared invasive blood pressure (IBP) measurements with both the non-invasive methods (CS-BP and NIBP) in a sub-group of patients (n = 10) who required arterial blood pressure monitoring. Results We analyzed 229 data points (116 supine, 113 beach chair) from the entire cohort; per patient measurements were based on surgical length (range 3–9 supine, 2–10 beach chair). The mean difference (±SD; 95% limits of agreement) in the mean arterial pressure (MAP) between CS-BP and NIBP was − 0.9 (±11.0; − 24.0–22.2) in the beach chair position and − 4.9 mmHg (±11.8; − 28.0–18.2) when supine. In the sub-group, the difference between CS-BP and IBP in the beach chair position was − 1.6 mmHg (±16.0; − 32.9–29.7) and − 2.8 mmHg (±15.3; − 32.8–27.1) in the supine position. Between NIBP and IBP, we detected a difference of 3.0 mmHg (±9.1; − 20.8–14.7) in the beach chair position, and 4.6 mmHg (±13.3; − 21.4–30.6) in the supine position. Conclusions We found clinically acceptable mean differences in MAP measurements between the ClearSight™ and non-invasive oscillometric blood pressure systems when patients were in either the supine or beach chair position. For all comparisons of the monitoring systems and surgical positions, the standard deviations and limits of agreement were wide. Trial registration This study was prospectively registered at the German Clinical Trial Register (www.DRKS.de; DRKS00013773). Registered 26/01/2018.

Sign in / Sign up

Export Citation Format

Share Document