title: Accuracy in Blood Pressure Monitoring: The Effect of Noninvasive Blood Pressure Cuff Inflation on Intra-arterial Blood Pressure Values.
abstract: BACKGROUND
  Both invasive and noninvasive blood pressure (invasive arterial blood pressure [IABP] and noninvasive BP [NIBP]) monitors are used perioperatively; however, they often produce different values. The reason for this discrepancy is not clear, and it is possible that the act of cuff inflation itself might affect the IABP values, especially with the recurrent cycling of NIBP cuff.
  
  
  OBJECTIVE
  The aim of this study was to determine the effect of ipsilateral NIBP cuff inflation on the contralateral IABP values.
  
  
  METHODS
  Prospective, observational study.
  
  
  METHODS
  One hundred consecutive patients were studied. The NIBP device was set to cycle every 5 min for a total of 6 times. During each cuff inflation cycle, changes in IABP values from the arterial line in the contralateral arm were recorded. A total of 582 measurements were included for data analysis.
  
  
  METHODS
  Chi-square, pairedt-test, analysis of variance.
  
  
  RESULTS
  Mean (± standard deviation) changes in systolic BP (SBP), diastolic BP, and mean BP with cuff inflation were 6.7 ± 5.9, 2.6 ± 4.0, and 4.0 ± 3.9 mmHg, respectively. We observed an increase of 0-10 mmHg in SBP in majority (73.4%) of cuff inflations. The changes in IABP did not differ between the patients with or without hypertension or with the baseline SBP.
  
  
  CONCLUSIONS
  This study showed that there is a transient reactive rise in IABP values with NIBP cuff inflation. This is important information in the perioperative and intensive care settings, where both these measurement techniques are routinely used. The exact mechanism for this effect is not known but may be attributed to the pain and discomfort from cuff inflation.
authors.affiliation: Department of Anesthesia, Toronto Western Hospital, Toronto, Canada.
authors.forename: Veena
authors.initials: V
authors.lastname: Sheshadri
authors.affiliation: Department of Anesthesia, Toronto Western Hospital, Toronto, Canada.
authors.forename: Akhilesh Kumar
authors.initials: AK
authors.lastname: Tiwari
authors.affiliation: Department of Anesthesia and Perioperative Medicine, University of Western Ontario, Ontario, Canada.
authors.forename: Mahesh
authors.initials: M
authors.lastname: Nagappa
authors.affiliation: Department of Anesthesia, Toronto Western Hospital, Toronto, Canada.
authors.forename: Lashmi
authors.initials: L
authors.lastname: Venkatraghavan
keywords: Cuff inflation; intra-arterial blood pressure; noninvasive blood pressure