Evaluation of indirect blood pressure monitoring in awake and anesthetized red-tailed hawks (Buteo jamaicensis): effects of cuff size, cuff placement, and monitoring equipment

ObjectiveTo compare Doppler and oscillometric methods of indirect arterial blood pressure (IBP) with direct arterial measurements in anesthetized and awake red-tailed hawks.Study designProspective, randomized, blinded study.AnimalsSix, sex unknown, adult red-tailed hawks.MethodsBirds were anesthetized and IBP measurements were obtained by oscillometry (IBP-O) and Doppler (IBP-D) on the pectoral and pelvic limbs using three cuffs of different width based on limb circumference: cuff 1 (20–30% of circumference), cuff 2 (30–40%), and cuff 3 (40–50%). Direct arterial pressure measurements were obtained from the contralateral superficial ulnar artery. Indirect blood pressure measurements were compared to direct systolic arterial pressure (SAP) and mean arterial pressure (MAP) during normotension and induced states of hypotension and hypertension. Measurements were also obtained in awake, restrained birds. Three-way anova, linear regression and Bland–Altman analyses were used to evaluate the IBP-D data. Results are reported as mean bias (95% confidence intervals).ResultsThe IBP-O monitor reported errors during 54% of the measurements. Indirect blood pressure Doppler measurements were most accurate with cuff 3 and were comparable to MAP with a bias of 2 (?9, 13 mmHg). However, this cuff consistently underestimated SAP with a bias of 33 (19, 48 mmHg). Variability in the readings within and among birds was high. There was no significant difference between sites of cuff placement. Awake birds had SAP, MAP and diastolic arterial pressure that were 56, 43, and 38 mmHg higher than anesthetized birds.Conclusions and clinical relevanceIndirect blood pressure (oscillometric) measurements were unreliable in red-tailed hawks. Indirect blood pressure (Doppler) measurements were closer to MAP measurements than SAP measurements. There was slightly better agreement with the use of cuff 3 on either the pectoral or pelvic limbs. Awake, restrained birds have significantly higher arterial pressures than those under sevoflurane anesthesia.     

Evaluation of a new oscillometric blood pressure monitor in isoflurane-anesthetized dogs

Objective This study was conducted to evaluate the performance of a new veterinary oscillometric noninvasive blood pressure (NIBP) monitor in anesthetized dogs. Study design Assessment was made to determine how closely indirect measurements were associated with direct measurements, and if there were statistically significant differences between the measurements by site. Animals Six mongrel dogs weighing 27.8 ± 2.9 kg. Methods Dogs were anesthetized with thiopental and maintained with isoflurane, which was delivered with controlled ventilation. Direct pressure measurements were obtained via a percutaneously placed arterial catheter. A range of systolic arterial pressures (SAP) were achieved by changing the isoflurane concentrations. Sites of cuff placement for indirect measurements were identified as metacarpus, metatarsus, and anterior tibial. Results At pressures below 80 mm Hg, indirect systolic measurements averaged 4 ± 3 mm Hg, higher than the direct values. At normal and high levels, indirect systolic measurements underestimated direct values by 18 ± 6 and 23 ± 6 mm Hg, respectively. Diastolic and mean pressure measurements followed the same trend, with indirect values being lower than the direct arterial pressures. Systolic, diastolic and mean arterial pressure measurements differed by cuff‐placement site. Conclusions When analyzed by site and level, indirect systolic and mean arterial blood pressures during hypotension were essentially the same as direct pressures. However, at pressures within the normal or high range, indirect measurements underestimated the direct pressures. Clinical relevance Noninvasive blood pressure measurements with a new oscillometric monitor provided an excellent means of detecting arterial hypotension in anesthetized dogs. The metatarsal site for cuff placement was slightly better than the metacarpal or anterior tibial site, considering that the regression line was closest to complete equality between the indirect and direct measurements for SAP.     

Comparison of direct and indirect blood pressure measurements in anesthetized dogs.

The precision and accuracy of an indirect oscillometric blood pressure measurement technique (Dinamap 8100) was assessed in 11 anesthetized Beagle dogs weighing 8 to 11.5 kg. Direct blood pressure measurements were made by catheterization of the lingual artery, and simultaneous indirect measurements were determined by placing a cuff over the median artery (midradial area). Blood pressure measurements at 2 different planes of anesthesia (light and deep) were recorded in triplicate. At a light plane of anesthesia, the Dinamap 8100 underestimated diastolic and mean arterial pressure, and at a deep anesthetic plane overestimated systolic pressure. The indirect technique had good repeatability of systolic pressures. Regression analysis for the 2 techniques showed excellent correlation (r = 0.93). The results indicate that the indirect oscillometric blood pressure measurement technique provides a good estimate of systolic, diastolic, and mean arterial pressure in dogs weighing 8-11.5 kg.     

A clinical evaluation of an oscillometric blood pressure monitor on anesthetized horses

The accuracy of an oscillometric blood pressure monitor (Vet/BP 6000, Sensor Devices, Inc., Waukesha, WI) was assessed in 13 anesthetized horses undergoing a variety of clinical procedures. The oscillometric blood pressure measurements using a cuff placed around the base of the tail were compared to simultaneously recorded direct pressure readings. One hundred nine sets of blood pressure measurements were recorded. In addition the pulse rates, as determined by digital palpation and oscillometric measurement, the time required for an oscillometric measurement, and the number of attempts required by the oscillometric unit were recorded. The average difference between the direct and oscillometric blood pressures were 18, 9, and 11 mmHg for the systolic, diastolic and mean arterial blood pressures, respectively. The oscillometric and direct pressure measurements showed significant correlation with a correlation coefficient of 0.93 for the mean arterial pressure. The oscillometrically determined pulse rate (average-33 pulses/min) was significantly different than the pulse rate determined by palpation (average-33.4 pulses/minute) but the difference was less than one. The average time required for a determination was 69 seconds and the average number of attempts required was 1.02 per determination.     

Accuracy of indirect measurement of blood pressure in neonatal foals

The objectives of this study were to assess, in anesthetized neonatal foals, the accuracy of 2 automated indirect oscillometric monitors for measurement of mean arterial pressure (MAP), to determine the optimal site of cuff placement for MAP monitoring, and to determine the relationship between arterial blood pressure and cardiac output. Ten neonatal foals were anesthetized and instrumented with a catheter in the metatarsal artery for direct MAP monitoring and measurement of cardiac output by lithium dilution. Concurrent MAP measurements were obtained with Cardell and Dinamap oscillometric monitors with cuffs placed at 3 different sites (coccygeal, metatarsal, and median arteries). Blood pressure was manipulated by varying the depth of anesthesia and by administration of dobutamine or phenylephrine. A statistically significant (P = .025) interaction was found between the type of monitor and cuff placement site. With the Cardell monitor, placement of the cuff over the coccygeal artery resulted in a significantly lower bias than placement over the median or dorsal metatarsal artery (P < .0001 and P = .0149, respectively). No significant difference in bias was found with cuff placement site when using the Dinamap monitor. The correlation coefficient (r) between MAP and cardiac output was 0.47. Indirect oscillometry with a cuff placed over the coccygeal artery or dorsal metatarsal artery is an acceptable method for measuring MAP in foals. Blood pressure does not correlate well with cardiac output in anesthetized foals.     

Accuracy of an oscillometric blood pressure monitor during phenylephrine-induced hypertension in dogs

OBJECTIVE: To examine the agreement between direct arterial blood pressure measurements obtained from 2 arteries and indirect blood pressure measurements obtained with an oscillometric blood pressure monitor (OBPM) during normotension and phenylephrine-induced hypertension in dogs. ANIMALS: 16 male Beagles. PROCEDURES: In anesthetized dogs, arterial catheters were placed in the lingual and dorsal pedal arteries for measurement of arterial blood pressure. A blood pressure cuff was placed on either the dog's fore- or hind limb and connected to an OBPM. Systolic, diastolic, and mean arterial blood pressures (SAP, DAP, and MAP, respectively) were recorded from both arteries and the OBPM every 5 minutes for 30 minutes (baseline), during a 30-minute period in which dogs received a phenylephrine infusion IV to induce hypertension, and for 30 minutes after discontinuation of the infusion. Mean differences in blood pressure values and confidence intervals were calculated to compare the indirect and direct measurement techniques. RESULTS: In dogs, oscillometry underestimated SAP during normotension, and the difference between oscillometric and direct measurements increased during hypertension. Oscillometry underestimated DAP, but the difference between oscillometric and direct measurements decreased during hypertension. There was close agreement among techniques for MAP determinations. Biases between direct measurements and OPBM blood pressure values measured from dogs' forelimbs or hind limbs were not significantly different. CONCLUSIONS AND CLINICAL RELEVANCE: In normotensive dogs, oscillometric measurements of MAP and SAP agreed more closely with direct arterial pressure measurements than oscillometric estimates of DAP. Oscillometric measurement of MAP was accurate during both normotension and hypertension in dogs.     

Evaluation of oscillometric and Doppler ultrasonic methods of indirect blood pressure estimation in conscious dogs

To assess the accuracy and precision of indirect measurements of systemic arterial blood pressure (BP), results obtained with an oscillometric device (BPo) and a Doppler ultrasonic device (BPud) were compared with those obtained by direct radiotelemetry (BPrt) in 12 conscious beagles. The correlation between indirectly obtained and directly measured values for BP parameters ranged widely for the different indirect methods and sites of cuff placement, with R2 between 0.001 and 0.901. Both indirect methods underestimated all BP parameters, the degree of underestimation increasing at higher values for the BP. The highest correlation occurred when estimates were the average of 5 values consecutively obtained with the oscillometric device and cuff placement at the coccygeal artery (R2 = 0.854 for mean BPo, 0.886 for systolic BPo, and 0.901 for diastolic BPo; P < 0.0001 for all parameters) or with the ultrasonic Doppler device at the metatarsal arteries (R2 = 0.810 for systolic BPud; P < 0.0001). Multiple consecutively obtained values are advised, as this approach improves the reliability of indirect BP measurements. The strong correlation between directly measured values and estimates derived as the average of 5 consecutive indirectly obtained values indicates that the latter approach provides a useful estimate of BP in conscious dogs and is likely to be useful in monitoring disease progress and treatment in dogs with abnormal BP.     

Comparison of Doppler,oscillometric, auricular and carotid arterial blood pressure measurements in isoflurane anesthetized New Zealand white rabbits

ObjectiveTo assess agreement between carotid arterial pressure and auricular arterial, thoracic limb Doppler or thoracic limb oscillometric blood pressure measurements.Study designProspective experimental study.AnimalsSix adult New Zealand white rabbits.MethodsRabbits were anesthetized with isoflurane in oxygen at 1, 1.5 and 2 MAC on two separate occasions. Catheters in the auricular and the contralateral external carotid artery were connected to calibrated pressure transducers via non-compliant tubing. Inflatable cuffs of width equal to approximately 40% of the limb circumference were placed above the carpus on both thoracic limbs with a Doppler transducer placed distal to the cuff on one. Systolic (SAP) and mean (MAP) arterial blood pressure measurements were obtained at each dose, on each occasion. Agreement between measurement techniques was evaluated by repeated measures Bland Altman analysis with carotid pressure as the reference. Variation in bias over the measurement range was evaluated by regression analysis.ResultsCarotid MAP and SAP ranged from 20 to 65 mmHg and 37 to 103 mmHg respectively. Bias and 95% limits of agreement for auricular and oscillometric MAP were 7 (0–14) and ?5 (?21–11) mmHg, respectively, and for auricular, oscillometric and Doppler SAP were 23 (8–37), ?2 (?24–20) and 13 (?14–39) mmHg, respectively. Bias varied significantly over the measurement range (p < 0.001) for all three SAP techniques but not for MAP measurements.Conclusions and clinical relevanceLimits of agreement for all measurements were large but less so for MAP than SAP. Variation in bias with SAP should be considered when using these measurements clinically.     

Agreement of caudal aortic arterial blood pressure with oscillometry using two cuff widths placed on the thoracic or pelvic limbs of sevoflurane-anesthetized rabbits

ObjectiveTo evaluate agreement with central systemic arterial pressure of an oscillometer and two cuff widths placed on the thoracic or pelvic limbs.Study designProspective experimental study.AnimalsA group of nine New Zealand White rabbits weighing 3.5 ± 0.3 kg.MethodsRabbits were sedated with dexmedetomidine and midazolam, then anesthetized with ketamine and sevoflurane. The femoral artery was surgically exposed and a 20 gauge, 5 cm catheter inserted to measure systolic (SAP), mean (MAP) and diastolic (DAP) blood pressure at the iliac artery and caudal aorta junction. Adjustments of vaporizer dial and dobutamine infusion provided a range of invasive blood pressure (IBP). Two measurements of IBP were recorded during the oscillometer cycling phase, and the mean value was used in analyses. Oscillometer cuffs of bladder width 2.0 cm (S1) and 2.5 cm (S2) were placed proximal to the carpus and tarsus. Cuff width to circumference ratio was calculated. Oscillometer SAP, MAP and DAP were paired with corresponding IBP values. Agreement was assessed using linear mixed models (p < 0.05).ResultsCuff ratios for both limbs were 41% (S1 cuff) and 50% (S2 cuff) and 122–139 paired observations were obtained. There was significant limb × cuff interaction with SAP and MAP. The oscillometer overestimated SAP and MAP on the pelvic limb and underestimated SAP and MAP on the thoracic limb. For SAP, the oscillometer overestimated by constant bias (–19 ± 2 mmHg) and proportional bias (0.28 ± 0.02 mmHg per 1 mmHg increase). For MAP, the oscillometer underestimated by constant bias (4 ± 2 mmHg) and was worse with S2 on the thoracic limb. Overestimation was similar between cuffs on the pelvic limb. For DAP, the oscillometer underestimated by constant bias (15 ± 2 mmHg).Conclusions and clinical relevanceCuff S1 on the thoracic limb provided best estimation of MAP.     

Agreement between noninvasive oscillometric and invasive blood pressure measurements in isoflurane-anesthetized guinea pigs (Cavia porcellus)

ObjectiveTo assess the agreement between an oscillometric device and invasive blood pressure (IBP) measurements in anesthetized healthy adult guinea pigs.Study designProspective experimental study.AnimalsA total of eight adult Hartley guinea pigs.MethodsAll animals were anesthetized; a carotid artery was surgically exposed and catheterized for IBP measurements. A size 1 cuff placed on the right thoracic limb was connected to an oscillometric device for noninvasive blood pressure (NIBP) assessment. Concurrent pairs of systolic (SAP), diastolic (DAP) and mean (MAP) arterial pressures were recorded simultaneously with both methods every 3 minutes for 30 minutes. Agreement between IBP and NIBP measurements was determined using the Bland–Altman method, considering the recommended standards for the validation of NIBP measurement devices proposed by the American College of Veterinary Internal Medicine (ACVIM).ResultsThe bias and the 95% limits of agreement were: –14 (–31 to 3) mmHg, –2 (–14 to 10) mmHg and –1 (–13 to 11) mmHg for SAP, DAP and MAP, respectively.Conclusions and clinical relevanceThe oscillometric device used in this study to measure NIBP did not meet ACVIM criteria for validation. It showed good agreement for DAP and MAP but not for SAP measurements. Considering the small size of these animals and the resulting difficulty in performing percutaneous arterial catheterization, this device might be a useful tool to assess MAP and DAP during anesthetic procedures in adult guinea pigs.     

Agreement between direct, oscillometric and Doppler ultrasound blood pressures using three different cuff positions in anesthetized dogs

ObjectiveTo evaluate the agreement between invasive blood pressure (IBP) and Doppler ultrasound blood pressure (DUBP) using three cuff positions and oscillometric blood pressure (OBP) in anesthetized dogs.Study designProspective study.AnimalsNine adult dogs weighing 14.5–29.5 kg.MethodsThe cuff was placed above and below the tarsus, and above the carpus with the DUBP and above the carpus with the OBP monitor. Based on IBP recorded via a dorsal pedal artery catheter, conditions of low, normal, and high systolic arterial pressures [SAP (mmHg) <90, between 90 and 140, and >140, respectively] were induced by changes in isoflurane concentrations and/or dopamine administration. Mean biases ± 2 SD (limits of agreement) were determined.ResultsAt high blood pressures, regardless of cuff position, SAP determinations with the DUBP underestimated invasive SAP values by more than 20 mmHg in most instances. With the DUBP, cuff placement above the tarsus yielded better agreement with invasive SAP during low blood pressures (0.2 ± 16 mmHg). The OBP underestimated SAP during high blood pressures (?42 ± 42 mmHg) and yielded better agreement with IBP for mean (MAP) and diastolic (DAP) arterial pressure measurements [overall bias: 2 ± 15 mmHg (MAP) and 0.2 ± 16 mmHg (DAP)].ConclusionsAgreement of SAP determinations with the DUBP is poor at SAP > 140 mmHg, regardless of cuff placement. Measurement error of the DUBP with the cuff placed above the tarsus is clinically acceptable during low blood pressures. Agreement of MAP and DAP measurements with this OBP monitor compared with IBP was clinically acceptable over a wide pressure range.Clinical relevanceWith the DUBP device, placing the cuff above the tarsus allows reasonable agreement with IBP obtained via dorsal pedal artery catheterization. Only MAP and DAP provide reasonable estimates of direct blood pressure with the OBP monitor evaluated.     

Evaluation of the tongue for oscillometric measurement of arterial pressure in anesthetized Beagle dogs

ObjectiveTo evaluate the agreement between oscillometric blood pressure (OBP) measured from the tongue and invasive blood pressure (IBP), and to compare OBPs measured from the tongue with OBPs measured from the pelvic limb and tail.Study designProspective experimental study.AnimalsA total of eight adult Beagle dogs weighing 11.1 ± 1.2 kg.MethodsAnimals were premedicated with intravenous (IV) acepromazine (0.005 mg kg^–1). Anesthesia was induced with alfaxalone (3 mg kg^–1) IV and maintained with isoflurane. The dorsal pedal artery was catheterized for IBP measurements. Systolic (SAP), diastolic (DAP) and mean (MAP) arterial pressure were simultaneously measured from the tongue, pelvic limb and tail. Based on invasive SAP, hypertension (>140 mmHg), normotension (90–140 mmHg) and hypotension (<90 mmHg) were induced by controlling end-tidal isoflurane concentrations and/or dobutamine/dopamine administration. Agreement between paired IBP and OBP measurements was analyzed with reference standards for noninvasive blood pressure devices used in small animals and humans.ResultsRegardless of cuff placement, the mean bias ± standard deviation between IBP and OBP met veterinary (≤10 ± 15 mmHg) and human (<5 ± 8 mmHg) standards for MAP and DAP. SAP measurements provided by the OBP device showed unacceptable agreement with IBP, and the bias between methods increased at higher blood pressures, regardless of cuff site. During hypotension, tongue OBP showed the largest percentage of absolute difference <10 mmHg in relation to IBP for SAP (90%), MAP (97%), and DAP (93%), compared with pelvic limb (60%, 97% and 82%, respectively) and tail OBP (54%, 92% and 77%, respectively).Conclusions and clinical relevanceThe tongue is a clinically useful site for measuring OBP in anesthetized Beagle dogs, providing reliable estimates of MAP and DAP. The tongue could replace other cuff placement sites and may be a relatively suitable site for assessing hypotension.     

Adaptation of human oscillometric blood pressure monitors for use in dogs

Two digital oscillometric human blood pressure measuring devices were modified and evaluated as blood pressure monitors in 12 healthy anesthetized dogs. Direct arterial pressures were measured via cannulation of the dorsal pedal artery and were correlated with indirect measurements through an inflatable cuff placed over the dorsal pedal artery below the hock joint of the contralateral limb. Direct and indirect measurements were compared for systolic, diastolic, and calculated mean arterial pressures. Blood pressure ranges between 215/145 mm of Hg and 65/30 mm of Hg were obtained, using combinations of halothane, phenylephrine, calcium, and IV administered fluids. Machine A was found to be insufficient for clinical application, on the basis of correlation coefficients between direct and indirect pressures of 0.78, 0.65, and 0.74 for systolic, diastolic, and mean arterial pressures, respectively. Higher correlation coefficients between direct and indirect pressures (0.77, 0.87, and 0.87, respectively) were obtained with machine B. The results of the study reported here suggest machine B may be an effective blood pressure monitoring device in anesthetized dogs.     

Evaluation of an oscillometric blood pressure monitor for use in anesthetized cats

OBJECTIVE: To determine accuracy of an oscillometric blood pressure monitor used over a wide range of pressures in anesthetized cats. DESIGN: Prospective study. ANIMALS: 6 healthy cats. PROCEDURE: 4 female cats and 2 male cats that weighed 2.7 to 4.5 kg (5.9 to 9.9 lb) and were 2 to 8 years old were anesthetized. Blood pressure was measured directly with an arterial catheter placed in the right femoral artery and indirectly from the left antebrachium by use of an oscillometric monitor. A series of diastolic arterial pressure (DAP), mean arterial pressure (MAP), and systolic arterial pressure (SAP) measurements were obtained during hypotension, normotension, and hypertension. Values obtained indirectly and directly were compared. RESULTS: The oscillometric monitor was accurate for DAP and MAP throughout the entire pressure range and met the standards of the Association for the Advancement of Medical Instrumentation (mean +/- SD difference from values obtained directly, < or = 5 +/- 8 mm Hg). The SAP was increasingly underestimated with increasing overall pressure; mean differences from direct measurements were -5.2, -12.1, and -17.7 mm Hg during hypo-, normo-, and hypertension, respectively. Standard deviations for SAP were all < or = 8 mm Hg. The monitor gave readings during all attempts. The direct blood pressure recording system appeared to perform well with neither under- nor overdamping. CONCLUSIONS AND CLINICAL RELEVANCE: Except for a minor underestimation of SAP during normo- and hypertension, the oscillometric monitor yielded reliable and easily obtainable blood pressure measurements in anesthetized cats.     

Agreement between invasive and oscillometric arterial blood pressure measurement using a high-definition oscillometric device in normotensive New Zealand White rabbits using two different anaesthetic protocols

ObjectiveTo use American College of Veterinary Internal Medicine (ACVIM) criteria to evaluate a high-definition oscillometric (HDO) blood pressure monitoring device versus invasive blood pressure (IBP) measurement in normotensive rabbits anaesthetized with two different anaesthetic protocols.Study designProspective experimental study.AnimalsA group of 20 healthy adult New Zealand White rabbits weighing 4.36 ± 0.37 kg (mean ± standard deviation).Materials and methodsRabbits were premedicated with butorphanol 0.5 mg kg^–1 and midazolam 0.5 mg kg^–1 subcutaneously (SC, group BMA) or ketamine 25 mg kg^–1 and medetomidine 0.4 mg kg^–1 SC (group KM). Anaesthesia was induced with alfaxalone administered intravenously (group BMA) or isoflurane by face mask (group KM) and maintained with isoflurane in oxygen. IBP was measured from the central auricular artery. The cuff for the HDO monitor was placed distal to the left elbow and distal to the left tarsus. Agreement between invasive and HDO measurements was evaluated using Bland–Altman method.ResultsIn group KM there was better agreement between the HDO device and IBP when the cuff was placed on the thoracic limb, with 100% and 91% of the readings for mean (MAP) and diastolic arterial pressure (DAP), respectively, within 10 mmHg of the IBP measurements. The agreement, although worse, also met the ACVIM criteria for systolic arterial pressure (SAP; 53% of the readings within 10 mmHg). In group BMA, the device met the criteria with the cuff on the thoracic limb only, and only for MAP and DAP (73% and 75% of the measurements within 10 mmHg of the IBP, respectively) but not for SAP (12%).Conclusion and clinical relevanceThe HDO device met most of the ACVIM criteria for noninvasive blood pressure measurement in anaesthetized rabbits, specifically when the cuff was placed distal to the elbow and the anaesthetic protocol included ketamine and medetomidine.     

Comparison of high definition oscillometric and Doppler ultrasound devices with invasive blood pressure in anaesthetized dogs

Objective To use the American College of Veterinary Internal Medicine (ACVIM) validation criteria to evaluate the performance of high definition oscillometric (HDO) and Doppler blood pressure measurement techniques against invasive blood pressure measurements in anaesthetized dogs. Study design Prospective clinical study. Animals Twenty client‐owned dogs. Materials and Methods Invasive blood pressure was measured using a catheter inserted into a pedal artery and an electronic transducer. The sites of cuff placement for the HDO measurements were the mid antebrachium or the proximal tail and, for the Doppler technique, the distal tibia. Agreement between invasive and non‐invasive blood pressure measurements was estimated by the Bland–Altman method. Results Only 10% and 34% of Doppler measurements were within 10 and 20 mmHg of invasive blood pressure values, respectively. The Doppler device failed to meet the ACVIM validation criteria for blood pressure measurement devices. The best agreement between HDO and invasive blood pressure measurement technique was observed for mean arterial blood pressure (MAP); 67% and 95% of readings were within 10 and 20 mmHg of invasive blood pressure values respectively. In addition, 52% and 87% of diastolic arterial blood pressure (DAP) measurements were within 10 and 20 mmHg of invasive readings. High definition oscillometric readings did not meet ACVIM recommended limits for SAP. Conclusion and clinical relevance The Doppler technique overestimated and the HDO device showed limited agreement with invasive blood pressure measurement in anaesthetized dogs. High definition oscillometry met most of the ACVIM requirements for MAP and DAP while the Doppler technique did not.     

IMAGING DIAGNOSIS—AORTIC THROMBOEMBOLISM ASSOCIATED WITH SPIROCERCOSIS IN A DOG

An 8-year-old neutered female Rhodesian Ridgeback developed acute, nonneurological right pelvic limb lameness. Femoral pulsation was poor, and oscillometric blood pressure measurements between the two pelvic limbs differed markedly. A caudal aortic right external iliac embolus was detected sonographically. Radiographically, there was a caudal esophageal mass and thoracic vertebral spondylitis typical of spirocercosis. Using CT-angiography, a caudal thoracic aortic aneurysm with a mural thrombus was detected. The dog recovered following heparin and aspirin therapy but signs recurred 7 months later. Subsequently, the patient improved on treatment and remains asymptomatic. This report illustrates the value of CT-angiography in detecting aortic thrombosis in dogs with spirocercosis.     

A study of measurement of noninvasive blood pressure with the oscillometric device,Sentinel, in isoflurane‐anaesthetized horses

ObjectiveTo assess accuracy of noninvasive blood pressure (NIBP) measured by oscillometric device Sentinel compared to invasive blood pressure (IBP) in anaesthetized horses undergoing surgery. To assess if differences between the NIBP measured by the Sentinel and IBP are associated with recumbency, cuff placement, weight of the horse or acepromazine premedication and to describe usefulness of the Sentinel.Study designProspective study examining replicates of simultaneous NIBP and IBP measurements.AnimalsTwenty-nine horses.MethodsInvasive blood pressure was measured via a catheter in the facial artery, transverse facial artery or metatarsal artery. NIBP was measured using appropriate size cuffs placed on one of two metacarpal or metatarsal bones or the tail in random order. With both techniques systolic (SAP), mean (MAP), and diastolic (DAP) arterial blood pressures and heart rates (HR) were recorded. A mixed effects model compared the IBP to the NIBP values and assessed potential effects of catheter placement, localisation of the cuffs in combination with recumbency, weight of the horse or acepromazine premedication.ResultsNoninvasive blood pressure yielded higher measurements than IBP. Agreement varied with recumbency and cuff position. Estimated mean differences between the two methods decreased from SAP (lateral recumbency: range -5.3 to -56.0 mmHg; dorsal recumbency: range 0.8 to -20.7 mmHg), to MAP (lateral recumbency: range -1.8 to -19.0 mmHg; dorsal recumbency: range 13.9 to -16.4 mmHg) to DAP (lateral recumbency: range 0.5 to -6.6 mmHg; dorsal recumbency: range 21.0 to -15.5 mmHg). NIBP measurement was approximately two times more variable than IBP measurement. No significant difference between IBP and NIBP due to horse's weight or acepromazine premedication was found. In 227 of 1047 (21.7%) measurements the Sentinel did not deliver a result.Conclusion and clinical relevanceAccording to the high variability of NIBP compared to IBP, NIBP measurements as measured by the Sentinel in the manner described here are not considered as an appropriate alternative to IBP to measure blood pressure in anaesthetized horses.     

Indirect oscillometric and direct blood pressure measurements in anesthetized and conscious neonatal foals

Objective: To investigate the agreement between indirect oscillometric and direct blood pressure measurement in the equine neonate. Design: Prospective observational study. Setting: University Veterinary Teaching Hospital. Animals: Ten crossbred foals of 30–46 hours of age. Interventions: Six animals (Group 1) were anesthetized. Four animals (Group 2) were restrained on a mat. All animals were instrumented with a catheter in the greater metatarsal artery and an oscillometric blood pressure cuff over the coccygeal artery. Blood pressure was varied with dobutamine, phenylephrine, nitroprusside, and increased depth of anesthesia (Group 1) or dopamine (Group 2). Measurements and main results: Simultaneous direct and indirect blood pressure measurements were obtained from the greater metatarsal artery and the coccygeal artery, respectively. There was good agreement between the 2 methods for mean and diastolic blood pressures in both groups, but not for systolic pressure. The agreement was best in mean blood pressure of anesthetized foals (mean bias –1.07; limits of agreement – 9.39, 7.25 mmHg). Conclusions: Indirect oscillometry appears to be an acceptable method for measuring mean arterial blood pressure in both anesthetized and conscious neonatal foals, and may be a valid method of monitoring critically ill foals.     

Doppler Ultrasonographic, Oscillometric Sphygmomanometric, and Photoplethysmographic Techniques for Noninvasive Blood Pressure Measurement in Anesthetized Cats

Blood pressure (BP) measurements obtained using 3 indirect BP measuring instruments, a Doppler ultrasonic flowmeter, an oscillometric device, and a photoplethysmograph, were compared with direct arterial pressure measurements in 11 anesthetized cats. The standard deviation of the differences (SOD) between direct and indirect pressure measurements were not significantly different from each other ( P <.01), and ranged from 10.82 to 24.32 mm Hg. The high SDD values indicate that indirect BP estimates obtained with all these devices must be interpreted cautiously in individual patients. The mean errors (calculated as the sum of the differences between direct and indirect pressure measurements divided by the number of observations) of the 3 indirect devices were significantly different for systolic (SAP), diastolic (DAP), and mean (MAP) arterial pressures ( P <.05). The Doppler and photoplethysmographic devices had the highest overall accuracy, as indicated by mean error values of less than 10 mm Hg. Correlation coefficients varied from .88 to .96 for the Doppler flowmeter, and from .85 to .94 for the photoplethysmograph; for both devices, the regression line slopes were close to unity. The Doppler flowmeter detected a pulse under all experimental conditions. The photoplethysmograph was also efficient in obtaining BP measurements, obtaining over 90% of SAP, DAP, and MAP readings attempted. The oscillometric device was the least accurate, with mean error values varying from 10 to 22 mm Hg. Correlation coefficients were high (.90 to .94) for this device, but the slopes of the regression lines were 0.7 to 0.8, indicating a trend for increased error at higher BP. The oscillometric device tended to underestimate BP by increasing amounts as the BP increased. The oscillometric device was the least efficient device for obtaining BP measurements ( P <.01).