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Is Invasive Pressure Monitoring More Reliable Than Non-Invasive in Patients with Cardiovascular Pathology? - A Case

Andreia Fernandes1, Luísa Coimbra1, Inês Delgado1

  • 1Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal.

Revista Portuguesa De Cirurgia Cardio-Toracica E Vascular : Orgao Oficial Da Sociedade Portuguesa De Cirurgia Cardio-Toracica E Vascular
|April 28, 2018
PubMed

Insights

Invasive blood pressure monitoring can be inaccurate during carotid endarterectomy (CEA) in patients with diffuse atheromatosis. Noninvasive blood pressure (NIBP) monitoring may serve as a reliable alternative for blood pressure management in such cases.

Area of Science:

  • Cardiovascular Surgery
  • Anesthesiology
  • Vascular Medicine

Background:

  • Carotid endarterectomy (CEA) necessitates precise arterial blood pressure (BP) management for optimal cerebral perfusion.
  • Invasive blood pressure (IBP) monitoring is standard but susceptible to artifacts, potentially yielding inaccurate readings.
  • Diffuse atheromatosis presents a challenge for accurate BP monitoring during CEA.

Observation:

  • A case of CEA in a 64-year-old male with diffuse atheromatosis, dyslipidemia, and hypertension is presented.
  • Intraoperative IBP readings showed a significant discrepancy with noninvasive blood pressure (NIBP) measurements, particularly with carotid stump pressure.
  • NIBP was utilized for BP management, guiding therapeutic targets throughout the procedure and postoperative period.

Findings:

  • A substantial difference between IBP and NIBP (>40 mmHg) was observed, attributed to diffuse atheromatosis.
  • NIBP measurements correlated with carotid stump pressure, suggesting its reliability in this specific clinical scenario.
  • Despite an initial hypertensive crisis leading to a cervical hematoma requiring reoperation, NIBP monitoring proved adequate postoperatively.

Implications:

  • IBP monitoring's accuracy may be compromised in patients with diffuse atheromatosis.
  • NIBP can serve as a viable, albeit non-continuous, alternative for BP monitoring when IBP is unreliable during CEA.
  • Accurate BP monitoring is critical for preventing cerebrovascular complications and ensuring patient safety during and after CEA.
Abstract

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