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LETTERS TO EDITOR
Year : 2022  |  Volume : 23  |  Issue : 1  |  Page : 73-74
 

Measurement of noninvasive blood pressure during general anesthesia in lateral decubitus position: A survey on existing knowledge and practice among anesthesiologists


1 Department of Neuroanaesthesia, Christian Medical College, Vellore, Tamil Nadu, India
2 Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India

Date of Submission07-Mar-2021
Date of Acceptance14-Mar-2021
Date of Web Publication23-Mar-2022

Correspondence Address:
Dr. Ramamani Mariappan
Department of Neuroanaesthesia, Christian Medical College, Vellore - 632 004, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/TheIAForum.TheIAForum_37_21

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How to cite this article:
Mariappan R, Lionel KR, Lakshmanan J. Measurement of noninvasive blood pressure during general anesthesia in lateral decubitus position: A survey on existing knowledge and practice among anesthesiologists. Indian Anaesth Forum 2022;23:73-4

How to cite this URL:
Mariappan R, Lionel KR, Lakshmanan J. Measurement of noninvasive blood pressure during general anesthesia in lateral decubitus position: A survey on existing knowledge and practice among anesthesiologists. Indian Anaesth Forum [serial online] 2022 [cited 2022 May 23];23:73-4. Available from: http://www.theiaforum.org/text.asp?2022/23/1/73/340482




Sir,

In lateral decubitus position (LDP), the noninvasive blood pressure (NiBP) in the dependent arm reads higher, and the nondependent arm reads lower in relation to supine NiBP due to the hydrostatic effect. This has been examined in pregnant patients and those with stroke, and it is evident that the dependent arm BP is closer to supine BP, whereas the nondependent arm measurements are lower compared to supine BP.[1],[2],[3] It has also been shown that the average BP from both the dependent and the nondependent arm is closer to supine BP in a normotensive term pregnant woman.[1],[2] We performed a prospective observational study assessing the correlation between the NiBP with arterial BP (ABP) in patients undergoing surgery under general anesthesia in LDP. Results revealed that the dependent arm NiBP correlated well with ABP and nondependent arm NiBP had poor correlation with NiBP during the progression of general anesthesia (GA).[4] Although our study[4] and the other studies[1],[2],[3] have shown that dependent arm NiBP gives closer value to supine BP, the practice varies among anesthesiologists, and there are no formal guidelines/recommendations regarding the site of application of NiBP cuff in LDP under anesthesia.

We performed a survey (IRB No-12484) among 420 practicing anesthesiologists to assess their knowledge, practice, and attitudes regarding NiBP measurements in LDP during GA. A 12-question survey was created using Google Forms App and circulated through a social media platform for 8 weeks. It explored four domains: professional experience, preferred arm (dependent vs. nondependent) to measure NiBP in LDP and the reason for choosing, arm preference in relation to the duration of GA, and knowledge toward available guidelines/recommendations. The survey had a 73% response rate (n = 310). Both trainees and consultants responded with a ratio of 34:66. Surprisingly, about two-third (n = 237, 76.5%) of the respondents preferred the nondependent arm in LDP under GA [Figure 1]a. Of those who preferred the nondependent arm, 177 (75%) felt that the axillary artery compression in the dependent arm was the reason for avoiding it and 39 (17%) felt that the nondependent arm gives an accurate reading.
Figure 1: Arm preference (dependent vs. nondependent) at the start of anaesthesia (a), as anaesthesia progresses (b) in lateral decubitus position. Expressed as a percentage of responders

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Only one-third of the respondents preferred the dependent arm (n = 73, 23.5%) [Figure 1]a. Of these, 47 (15%) of them were consultants, and 25 (8%) were trainees. Among those who chose the dependent arm, 32 (45%) felt that they chose it for accuracy, and 35 (50%) felt that the nondependent arm gives a lower value. With regard to anesthesia progression, 219 (71%) respondents thought that the nondependent arm BP is comparable to ABP. Only 89 (25%) felt that the dependent arm NiBP would be close to invasive BP [Figure 1]b. Majority of the respondents (96%, n = 297) were not aware of any studies and guidelines/recommendations in relation to NIBP measurements in LDP. It was evident from our survey that only one out of 4 (23%) respondents preferred the dependent arm for measuring the NiBP in LDP and only one out of 5 (21%) chose the right reason.

It is worth emphasizing that the dependent arm BP correlates well with invasive BP based on the available literature. This may have clinical implications not just in locations with limited resources for invasive monitoring but also to guide clinical judgment whenever NiBP is warranted in LDP under anesthesia.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Goldkrand JW, Jackson MJ. Blood pressure measurement in pregnant women in the left lateral recumbent position. Am J Obstet Gynecol 1997;176:642-3.  Back to cited text no. 1
    
2.
Kinsella SM. Effect of blood pressure instrument and cuff side on blood pressure reading in pregnant women in the lateral recumbent position. Int J Obstet Anesth 2006;15:290-3.  Back to cited text no. 2
    
3.
Aries MJ, Elting JW, Stewart RE, de Keyser J, Thien T, Kremer BP, et al. Variations of blood pressure in stroke unit patients may result from alternating body positions. J Stroke Cerebrovasc Dis 2012;21:459-66.  Back to cited text no. 3
    
4.
Thomas AS, Moorthy RK, Raju K, Lakshmanan J, Joy M, Mariappan R. Measurement of non-invasive blood pressure in lateral decubitus position under general anaesthesia – Which arm gives more accurate BP in relation to invasive BP – Dependent or non-dependent arm? Indian J Anaesth 2020;64:631-6.  Back to cited text no. 4
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