Inconsistency between simultaneous blood pressure measurements in the arm, forearm, and leg in anesthetized children.
OBJECTIVE
To determine the accuracy and precision of simultaneous noninvasive blood pressure (NIBP) measurement in the arm, forearm, and ankle in anesthetized children.


METHODS
Prospective, randomized study.


METHODS
University medical center.


METHODS
101 ASA physical status 1 and 2 children (aged 1-8 yrs) scheduled for elective surgery with general anesthesia.


METHODS
Simultaneous NIBP measurements were recorded at the arm, forearm, and ankle at 5-minute intervals.


RESULTS
The systolic blood pressure difference between the arm-forearm or the arm-ankle was within the ± 10% range in 63% and 29% of measurements, and within the ± 20% range in 85% and 67% of measurements, respectively. The diastolic blood pressure difference between the arm-forearm or the arm-ankle was within the ± 10% range in 42% and 44% and within the ± 20% range in 67% and 74% of measurements, respectively. In patients in whom the initial three NIBP measurements were within the ± 20% range between the forearm and arm, 86% of the subsequent measurements were also within that limit.


CONCLUSIONS
Forearm and ankle NIBP measurements are unreliable and inconsistent with NIBP measured in the arm of anesthetized children. These alternative BP measurement sites are not reliable in accuracy (comparison with reference "gold" standard) and precision (reproducibility).
Department of Anesthesiology and Intensive Care, Sheba Medical Center, Tel Hashomer,Israel (affiliated with Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel); Department of Anesthesiology, College of Medicine, University of Florida, Gainesville, FL 32610-0254, USA.
Ilan
I
Keidan
Department of Anesthesiology, College of Medicine, University of Florida, Gainesville, FL 32610-0254, USA. Electronic address: asidi@anest.ufl.edu.
Avner
A
Sidi
Department of Anesthesiology and Intensive Care, Sheba Medical Center, Tel Hashomer,Israel (affiliated with Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel).
Erez
E
Ben-Menachem
Department of Anesthesiology and Intensive Care, Sheba Medical Center, Tel Hashomer,Israel (affiliated with Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel).
Yael
Y
Tene
Department of Anesthesiology and Intensive Care, Sheba Medical Center, Tel Hashomer,Israel (affiliated with Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel).
Haim
H
Berkenstadt
D000768:Anesthesia, General / Q000379:methods*; D000842:Ankle / Q000098:blood supply; D001132:Arm / Q000098:blood supply*; D001794:Blood Pressure / Q000502:physiology*; D001795:Blood Pressure Determination; D002648:Child; D002675:Child, Preschool; D005260:Female; D005542:Forearm / Q000098:blood supply; D006801:Humans; D007223:Infant; D007866:Leg / Q000098:blood supply*; D008297:Male; D011446:Prospective Studies; D015203:Reproducibility of Results
Arm; Blood pressure; Children; Forearm; Leg