Agreement between noninvasive blood pressure obtained by an automated oscillometric blood pressure monitor and invasive blood pressure measurements in anesthetized pumas (Puma concolor)

OBJECTIVE: To evaluate agreement between noninvasive blood pressure (NIBP) obtained using an automated oscillometric blood pressure monitor and invasive blood pressure (IBP) measurements in anesthetized pumas (Puma concolor). STUDY DESIGN: Prospective experimental trial. ANIMALS: A group of five healthy adult captive pumas. METHODS: Pumas were anesthetized by intramuscular injection of ketamine, midazolam, dexmedetomidine, and methadone, followed by total intravenous anesthesia with propofol, remifentanil, ketamine, and lidocaine. NIBP was measured at the tail base using an oscillometric device, whereas IBP was obtained via dorsal pedal artery catheterization. Paired systolic (SAP), mean (MAP), and diastolic (DAP)_arterial blood pressures measurements were recorded every 5 minutes. Agreement was assessed using repeated-measures Bland-Altman analysis accounting for within-animal clustering. RESULTS: A total of 163 paired measurements were analyzed. Noninvasive measurements systematically underestimated IBP for SAP, MAP, and DAP. Bias (95% limits of agreement) was -11.8 (-41.1 to +17.4) mmHg for SAP, -8.7 (-32.1 to +14.7) mmHg for MAP, and -8.8 (-35.1 to +17.5) mmHg for DAP. Proportional bias was identified for SAP but not for MAP or DAP. The percentages of measurements that differed by ≤10 mmHg were 57.1% for MAP, 53.9% for DAP, and 41.1% for SAP. Measurements differing by ≤20 mmHg were 88.2% for MAP, 82.8% for DAP, and 73.6% for SAP. CONCLUSION AND CLINICAL RELEVANCE: The evaluated oscillometric device cannot be considered interchangeable with IBP monitoring in anesthetized pumas. Of the arterial blood pressure variables, MAP showed the most consistent agreement with IBP, although individual measurements may be associated with clinically relevant error.