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Wrist NIBP During Elective Cesarean Delivery
Comparison of Arm and Forearm Blood Pressure During Elective Cesarean Delivery
Studie Overzicht
Toestand
Gedetailleerde beschrijving
Upper arm non-invasive blood pressure (NIBP) measurement is the most commonly accepted method of blood pressure (BP) monitoring. During a cesarean delivery it may be challenging to obtain an accurate measurement from the automated devices in over 50% of the attempts due to arm movement.1 Patients may voluntarily move their arm, but more often neuraxial (spinal, epidural, combined spinal-epidural) anesthesia is known to induce shivering that causes the patient's arm to shake.2 To eliminate the effect of movement of the upper arm, NIBP has been tested on the leg because it is immobilized during neuraxial anesthesia. However, studies monitoring NIBP on an ankle or a calf were unable to accurately detect changes (increase or decrease) in blood pressure in patients undergoing a cesarean delivery.3,4 It seems clinically reasonable that in the case of a shivering patient, the forearm, with less muscle mass, would shake less and could be stabilized more easily than the upper arm (stabilizing the forearm is easily done by holding the patient's hand with a light pressure on the arm rest). Therefore, positioning an NIBP cuff on the forearm (near the wrist) may be useful to obtain an accurate blood pressure measurement in shivering patients.
Previous studies have found that forearm BP overestimates blood pressure measured at the upper arm in a variety of clinical settings and patient populations under static (patient at rest, not submitted to an intervention that might alter BP) circumstances.5-8 It is unknown whether this overestimation is clinically relevant when blood pressure change occurs rapidly, such as during a cesarean delivery. During neuraxial anesthesia for cesarean delivery, it is important for the anesthesiologist to know both absolute values and clinically significant changes in blood pressure to determine their treatment. The detection of dynamic changes in blood pressure (as when the patient is submitted to an intervention that might alter BP per se, e.g. neuraxial anesthesia) has been studied in obstetric patients. Nevertheless, either due to the location where the BP cuff was placed4 (as on the lower limb with interference of the aorto-caval compression) or to the technology used to measure blood pressure,9 (the penaz technology was not consistent with oscillometric technology in a previous study) the forearm blood pressure was not comparable to upper arm blood pressure when measured using an oscillometric monitor.
This study will compare the upper arm (the current gold-standard) and the forearm NIBP measurements in patients undergoing an elective cesarean delivery under subarachnoid anesthesia. We hypothesize that the forearm systolic BP measurement values will be within 10% (lower or higher) of the systolic BP values measured in the upper arm at the same time-points
Studietype
Inschrijving (Werkelijk)
Contacten en locaties
Studie Locaties
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British Columbia
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Vancouver, British Columbia, Canada, V6H 3N1
- British Columbia's Women's Hospital
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Deelname Criteria
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
Accepteert gezonde vrijwilligers
Geslachten die in aanmerking komen voor studie
Bemonsteringsmethode
Studie Bevolking
Beschrijving
Inclusion Criteria:
- Healthy (American Society of Anesthesiologist's (ASA) physical status I or II) patients
- Having an elective cesarean delivery under spinal or combined spinal epidural anesthesia
- ≥19 years old
Exclusion Criteria:
- Contra-indication to neuraxial anesthesia
- General anesthesia for any reason prior to delivery of the baby
- Use of the epidural component (epidural top-up) of combined spinal epidural anesthesia (prior to delivery of the baby)
- History of cardiovascular disease, e.g. hypertension (either essential or pregnancy-induced)
- A difference of more than 10% between both upper arms and forearms in mean blood pressure measurement prior to surgery (see below)
- BMI >35kg/m2 (it is more difficult to ensure the cuff size is correct in these obese patients)
- Inability to read and understand English for the purpose of informed consent
Studie plan
Hoe is de studie opgezet?
Ontwerpdetails
Cohorten en interventies
Groep / Cohort |
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Pregnant women
Pregnant women undergoing a cesarean section
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Wat meet het onderzoek?
Primaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
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Compare trends in NIBP measurements between the upper arm and forearm
Tijdsspanne: 30 minutes
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Measure NIBP at the upper arm and forearm simultaneously during surgery.
NIBP cuffs will be on opposite arms.
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30 minutes
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Secundaire uitkomstmaten
Uitkomstmaat |
Tijdsspanne |
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To estimate the accuracy of blood pressure measured on the forearm
Tijdsspanne: 30 minutes
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30 minutes
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Medewerkers en onderzoekers
Sponsor
Onderzoekers
- Hoofdonderzoeker: Simon Massey, MD, University of British Columbia, BC Women's Hospital
Studie record data
Bestudeer belangrijke data
Studie start
Primaire voltooiing (Werkelijk)
Studie voltooiing (Werkelijk)
Studieregistratiedata
Eerst ingediend
Eerst ingediend dat voldeed aan de QC-criteria
Eerst geplaatst (Schatting)
Updates van studierecords
Laatste update geplaatst (Schatting)
Laatste update ingediend die voldeed aan QC-criteria
Laatst geverifieerd
Meer informatie
Termen gerelateerd aan deze studie
Trefwoorden
Andere studie-ID-nummers
- H12-01797
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