Continuous finger-cuff arterial pressure monitoring reduced the area under a mean arterial pressure of 65 mmHg within 15 min of anesthesia induction (estimated location shift -6 mmHg x min; P=0.004).
RCT (n=242)
Open-label
randomized
No
Does continuous finger-cuff arterial pressure monitoring reduce hypotension in noncardiac surgery patients?
Continuous finger-cuff arterial pressure monitoring significantly reduces hypotension during induction of anesthesia and noncardiac surgery compared to intermittent oscillometric monitoring.
Mean Difference: -6 (95% CI -15–-0.3)
Absolute Event Rate: 7% vs 19%
p-value: p=0.004
BACKGROUND: Finger-cuff methods allow noninvasive continuous arterial pressure monitoring. This study aimed to determine whether continuous finger-cuff arterial pressure monitoring helps clinicians reduce hypotension within 15 min after starting induction of anesthesia and during noncardiac surgery. Specifically, this study tested the hypotheses that continuous finger-cuff-compared to intermittent oscillometric-arterial pressure monitoring helps clinicians reduce the area under a mean arterial pressure of 65 mmHg within 15 min after starting induction of anesthesia and the time-weighted average mean arterial pressure less than 65 mmHg during noncardiac surgery. METHODS: In this single-center trial, 242 noncardiac surgery patients were randomized to unblinded continuous finger-cuff arterial pressure monitoring or to intermittent oscillometric arterial pressure monitoring (with blinded continuous finger-cuff arterial pressure monitoring). The first of two hierarchical primary endpoints was the area under a mean arterial pressure of 65 mmHg within 15 min after starting induction of anesthesia; the second primary endpoint was the time-weighted average mean arterial pressure less than 65 mmHg during surgery. RESULTS: Within 15 min after starting induction of anesthesia, the median (interquartile range) area under a mean arterial pressure of 65 mmHg was 7 (0, 24) mmHg × min in 109 patients assigned to continuous finger-cuff monitoring versus 19 (0.3, 60) mmHg × min in 113 patients assigned to intermittent oscillometric monitoring (P = 0.004; estimated location shift: -6 95% CI: -15 to -0.3 mmHg × min). During surgery, the median (interquartile range) time-weighted average mean arterial pressure less than 65 mmHg was 0.04 (0, 0.27) mmHg in 112 patients assigned to continuous finger-cuff monitoring and 0.40 (0.03, 1.74) mmHg in 115 patients assigned to intermittent oscillometric monitoring (P < 0.001; estimated location shift: -0.17 95% CI: -0.41 to -0.05 mmHg). CONCLUSIONS: Continuous finger-cuff arterial pressure monitoring helps clinicians reduce hypotension within 15 min after starting induction of anesthesia and during noncardiac surgery compared to intermittent oscillometric arterial pressure monitoring.
Kouz et al. (Fri,) conducted a rct in Noncardiac surgery (n=242). Continuous finger-cuff arterial pressure monitoring vs. Intermittent oscillometric arterial pressure monitoring was evaluated on Area under a mean arterial pressure of 65 mmHg within 15 min after starting induction of anesthesia (estimated location shift -6, 95% CI -15 to -0.3, p=0.004). Continuous finger-cuff arterial pressure monitoring reduced the area under a mean arterial pressure of 65 mmHg within 15 min of anesthesia induction (estimated location shift -6 mmHg x min; P=0.004).
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