title: Agreement between radial and femoral arterial blood pressure measurements during orthotopic liver transplantation.
abstract: OBJECTIVE
  To study agreement between radial and femoral arterial pressure measurements in orthotopic liver transplantation (OLTx) surgery to determine whether arterial cannulation sites are interchangeable.
  
  
  METHODS
  Prospective observational study of 25 patients undergoing OLTx surgery.
  
  
  METHODS
  Radial and femoral arteries were cannulated with standardised arterial line kits. Radial and femoral mean arterial pressure (MAP), systolic arterial pressure (SAP), diastolic arterial pressure (DAP) and pulse pressure (PP) were measured at four time points (30 minutes after induction of anaesthesia, 30 minutes after the start of the anhepatic phase, 30 minutes after liver graft reperfusion and 30 minutes after the start of bile duct anastomosis).
  
  
  METHODS
  The bias, precision and limits of agreement between radial and femoral arterial pressures were calculated in accordance with Bland-Altman statistics.
  
  
  RESULTS
  Radial-femoral differences in MAP (mean difference, 4.8 mmHg [SD, 4.5 mmHg]), limits of agreement (- 13.6 and 8.8, P < 0.001) and DAP showed clinically acceptable agreement between measurement sites across all time points. However, clinically significant differences between radial and femoral SAPs (mean difference, - 14.9 mmHg [SD, 24.8 mmHg]) and limits of agreement (- 63.5 and 33.7, P < 0.001) occurred overall. This difference started after portal vein clamping and remained significant throughout the remainder of the operation.
  
  
  CONCLUSIONS
  Radial artery SAP underestimates femoral artery measurements significantly but unpredictably. As femoral measurement is more likely to reflect central arterial pressure, radial SAP measurement is not reliable in adults undergoing OLTx.
authors.affiliation: Department of Anaesthesia, Austin Hospital, Melbourne, VIC, Australia. matthew.lee2@austin.org.au.
authors.forename: Matthew
authors.initials: M
authors.lastname: Lee
authors.affiliation: Department of Anaesthesia, Austin Hospital, Melbourne, VIC, Australia.
authors.forename: Laurence
authors.initials: L
authors.lastname: Weinberg
authors.affiliation: Department of Anaesthesia, Austin Hospital, Melbourne, VIC, Australia.
authors.forename: Brett
authors.initials: B
authors.lastname: Pearce
authors.affiliation: Department of Anaesthesia, Austin Hospital, Melbourne, VIC, Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Scurrah
authors.affiliation: Department of Anaesthesia, Austin Hospital, Melbourne, VIC, Australia.
authors.forename: David A
authors.initials: DA
authors.lastname: Story
authors.affiliation: Department of Anaesthesia, Austin Hospital, Melbourne, VIC, Australia.
authors.forename: Param
authors.initials: P
authors.lastname: Pillai
authors.affiliation: Department of Anaesthesia, Austin Hospital, Melbourne, VIC, Australia.
authors.forename: Peter R
authors.initials: PR
authors.lastname: McCall
authors.affiliation: Department of Anaesthesia, Austin Hospital, Melbourne, VIC, Australia.
authors.forename: Larry P
authors.initials: LP
authors.lastname: McNicol
authors.affiliation: Department of Anaesthesia, Austin Hospital, Melbourne, VIC, Australia.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Peyton
mesh_terms: D000328:Adult; D062186:Arterial Pressure / Q000502:physiology*; D001795:Blood Pressure Determination; D005260:Female; D005263:Femoral Artery / Q000503:physiopathology*; D006801:Humans; D017093:Liver Failure / Q000503:physiopathology* / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011446:Prospective Studies; D017534:Radial Artery / Q000503:physiopathology*; D015203:Reproducibility of Results