Intracranial Pressure Monitoring via medscape. Evoked potentials: anesthetic effects via openanesthesia. Intraoperative Neurophysiological Monitoring via medscape. Nonobstetric Surgery During Pregnancy via acog. Using bispectral index and cerebral oximetry to guide hemodynamic therapy in high-risk surgical patients via perioperativemedicinejournal.
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By continuing use of our service you agree upon our Data Privacy Statement. Are you more of a visual learner? Check out our online video lectures and start your anesthesiology course now for free! Your path to achieve medical excellence. Study for medical school and boards with Lecturio. Votes: 2, average: 5. About the Lecturio Medical Online Library Our medical articles are the result of the hard work of our editorial board and our professional authors.
Recommended for you. September 22, Lecturio read more. November 12, Lecturio read more. Leave a Reply Cancel reply Register to leave a comment and get access to everything Lecturio offers! Leave a Reply Your email address will not be published. Create your free account. Become fluent in medicine with video lectures and Qbank. Do you want to learn even more? On the other hand, one might point out that invasive monitoring is not without its caveats. Specifically, the measured pressure depends on the site of measurement; as discussed in the chapter on normal arterial line waveforms, the values generated by invasive arterial pressure monitoring are subject to variation depending on how far distally the catheter is inserted.
To borrow and modify a classic diagram from an ancient copy of Gedde's Handbook of Blood Pressure Measurement :. So as you can see, all the values systolic, diastolic, mean are going to be different, depending on where you put the probe.
To ask which of these values is more "accurate" is meaningless, as all of them are presumably measured accurately within the limits of the transducer device and recording software. In other words, those are the actual pressure measurements from those arteries. The real question is, which of these pressures is the most important one for clinical use. You, standing there at the noradrenaline pump, will want to know whether to increase or decrease the infusion rate.
Even though most people in positions of authority seem to take the stance that aortic root pressure is the most "important" pressure, this is still a rather difficult question to answer. The actual clinical importance of the aortic root pressure values is open for debate, as the aortic root pressure is not the pressure that perfuses your renal medulla, or your cerebral hemispheres, for example.
However the fact remains that pressure at the aortic arch and carotid glomus which are basically the same is what your vasomotor autoregulatory centres monitor , and so it has at least physiological importance. The same cannot be said about the radial artery: your body does not care overmuch about the pressure there, and no important systemic cardiovascular decisions are made on the basis of it. Most patients in ICU end up with a radial arterial line not because that site is of clinical importance, but because it is safe and convenient.
Wherever the aortic root is accessed eg. Following from this, pressure which is collected closer to the aortic arch is more meaningful and "truer" than distal pressure, even if the proximal pressure is measured non-invasively. From Wax et al :. Because maintaining adequate blood pressure at vital organs is the usual goal of therapy, central pressure should probably be of more interest than peripheral pressure. Thus, brachial pressure measured by NIBP cuff may be a better measure of central pressure.
But, as we have already discussed, with worsening hypotension both the oscillometric and the auscultatory methods become increasingly less and less accurate. So, which measurement will you instruct the staff to go from?
The following take-home message can be distilled from everything discussed so far:. This simple series of statements can be represented by a graph, probably with no additional educational benefit:. Ward, Matthew, and Jeremy A. Meidert, Agnes S. Sorvoja, Hannu, and Risto Myllyla. Geddes, Leslie Alexander. Handbook of blood pressure measurement. Geddes, Leslie A. Lewis, Philip S. A technical note on behalf of the British and Irish Hypertension Society.
Lim, Pooi Khoon, et al. Posey, John Alton, et al. Bur, Andreas, et al. Chandraskehar, Anand, et al. Korotkoff, N. Babbs, Charles F. Drzewiecki, G. Melbin, and A. Juroszek, Barbara. Padwal, Raj, et al.
Landgraf, Johanna, Stanley H. Wishner, and Robert A. Caramella, J. Cohn, Jay N. Perloff, Dorothee, et al. Ribezzo, Sara, et al. Skirton, Heather, et al. Wax, David B. Knippa, Sara. Invasive and non-invasive measurement of blood pressure. Previous chapter: Methods of measurement of cardiac output and regional blood flow Next chapter: Indications and contraindications for arterial line insertion.
All SAQs related to this topic. All vivas related to this topic. In summary: Invasive direct blood pressure measurement Measures blood pressure directly by connecting the bloodstream to a pressure transducer, usually by a column of incompressible fluid eg.
Nuclear hormone receptors 1A. Thyroid hormone receptors 1B. Retinoic acid receptors 1C. Peroxisome proliferator-activated receptors 1D. Rev-Erb receptors 1F. Retinoic acid-related orphans 1H. Liver X receptor-like receptors 1I. Vitamin D receptor-like receptors 2A.
Hepatocyte nuclear factor-4 receptors 2B. Retinoid X receptors 2C. Testicular receptors 2E. Results: Overall, pairs of systolic and diastolic BP measurements were obtained. Systolic and diastolic pressures showed a difference of 2. In all, The difference was clinically acceptable in Both systolic and diastolic BP differences were correlated with the number of inotropes that the patient was receiving.
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