Key result
Continuous non-invasive blood pressure monitoring significantly reduced hypotensive readings below 55 mmHg compared to intermittent monitoring alone (7 vs. 25 readings, P=0.047).
Why the study?
Does continuous non-invasive blood pressure monitoring improve blood pressure stability and reduce hypotensive events in orthopaedic patients with chronic hypertension undergoing general anaesthesia?
RCT (n=160)
Single-blind
Randomised
No
Does continuous non-invasive blood pressure monitoring improve blood pressure stability and reduce hypotensive events in orthopaedic patients with chronic hypertension undergoing general anaesthesia?
Absolute Event Rate: 9.1% vs 30.1%
p-value: p=0.047
Continuous non-invasive blood pressure monitoring improves intraoperative blood pressure stability and reduces hypotensive events in hypertensive patients undergoing orthopaedic surgery.
Intermittent cuff monitoring may delay hypotension detection in hypertensive patients; leaves open whether continuous monitoring improves outcomes.
BACKGROUND: In patients undergoing general anaesthesia, intraoperative hypotension occurs frequently and is associated with adverse outcomes such as postoperative acute kidney failure, myocardial infarction or stroke. A history of chronic hypertension renders patients more susceptible to a decrease in blood pressure (BP) after induction of general anaesthesia. As a patient's BP is generally monitored intermittently via an upper arm cuff, there may be a delay in the detection of hypotension by the anaesthetist. OBJECTIVE: The current study investigates whether the presence of continuous BP monitoring leads to improved BP stability. DESIGN: Randomised, controlled and single-centre study. PATIENTS: A total of 160 orthopaedic patients undergoing general anaesthesia with a history of chronic hypertension. INTERVENTION: The patients were randomised to either a study group (n = 77) that received continuous non-invasive BP monitoring in addition to oscillometric intermittent monitoring, or a control group (n = 83) whose BP was monitored intermittently only. The interval for oscillometric measurements in both groups was set to 3 min. After induction of general anaesthesia, oscillometric BP values of the two groups were compared for the first hour of the procedure. Anaesthetists were blinded to the purpose of the study. MAIN OUTCOME MEASURE: BP stability and hypotensive events. RESULTS: There was no difference in baseline BP between the groups. After adjustment for multiple testing, mean arterial BP in the study group was significantly higher than in the control group at 12 and 15 min. Mean ± SD for study and control group, respectively were: 12 min, 102 ± 24 vs. 90 ± 26 mmHg (P = 0.039) and 15 min, 102 ± 21 vs. 90 ± 23 mmHg (P = 0.023). Hypotensive readings below a mean pressure of 55 mmHg occurred more often in the control group (25 vs. 7, P = 0.047). CONCLUSION: Continuous monitoring contributes to BP stability in the studied population. TRIAL REGISTRATION: NCT02519101.
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Meidert et al. (2017) conducted an RCT in Orthopaedic patients with chronic hypertension undergoing general anaesthesia (n=160). Continuous non-invasive blood pressure monitoring vs. Intermittent oscillometric monitoring only was evaluated on Blood pressure stability and hypotensive events (p=0.047). Continuous non-invasive blood pressure monitoring significantly reduced hypotensive readings below 55 mmHg compared to intermittent monitoring alone (7 vs. 25 readings, P=0.047).
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