The Accuracy of Perioperative Noninvasive Blood Pressure Monitoring in Obese Patients

To the Editor The recent narrative review by Kuck and Baker1 addressing both oscillometric and other continuous noninvasive blood pressure (NIBP) monitoring techniques for this ubiquitously standard perioperative monitor2 addresses several factors that may impact NIBP accuracy. Although some additional details could arguably have been provided, the authors do mention that the shape of the upper extremity where the cuff is applied has an impact on NIBP accuracy by altering the profile of the pressure being applied to the artery that is being oscillometrically interrogated beneath the NIBP cuff. Indeed, obese patients with a more frequently conical-shaped arm are of particular concern; however, Anast et al3 have recently shown that irrespective of arm morphology, NIBP measurements are often inaccurate in the obese, implying that invasive blood pressure monitoring may be of more value. Because obesity is found in approximately one-third of adults in the United States,4 understanding the implications of obesity on NIBP monitoring seems particularly relevant to note. Hilary P. Grocott, MD, FRCPC, FASEDepartment of Anesthesia, Perioperative & Pain MedicineUniversity of ManitobaWinnipeg, Manitoba, Canada[email protected]