Hypertension is a major factor leading to cardiovascular events and death, and accurate blood pressure measurement is a fundamental means of evaluating blood pressure levels, achieving hypertension diagnosis, and observing antihypertensive efficacy. Compared to traditional brachial pressure, central aortic pressure (CAP) exhibits a stronger correlation with cardiovascular events. However, its non-invasive detection technology has not yet been widely adopted in clinical practice. In order to promote the clinical application of CAP and optimize blood pressure management, this article systematically summarizes the research progress of CAP estimation algorithms. These algorithms were categorized into three types: direct substitution methods, generalized model-based methods and personalized estimation methods. The characteristics and clinical adaptability of each algorithm were analyzed. The findings highlight that CAP estimation algorithms are moving towards personalization and non-linearity.
Algorithms ; Humans ; Blood Pressure Determination/methods* ; Hypertension/physiopathology* ; Arterial Pressure/physiology* ; Blood Pressure/physiology* ; Aorta/physiology*

The alteration of pulmonary artery pressure is an important physiological indicator to reflect the organism's adaptation to acclimatization or the pathological injury in response to high-altitude hypoxic environment. The effects of hypoxic stress at different altitudes for different time on pulmonary artery pressure are different. There are many factors involved in the changes of pulmonary artery pressure, such as the contraction of pulmonary arterial smooth muscle, hemodynamic changes, abnormal regulation of vascular activity and abnormal changes of cardiopulmonary function. Understanding of the regulatory factors of pulmonary artery pressure in hypoxic environment is crucial in clarifying the relevant mechanisms of hypoxic adaptation, acclimatization, prevention, diagnosis, treatment and prognosis of acute and chronic high-altitude diseases. In recent years, great progress has been made in the study regarding the factors affecting pulmonary artery pressure in response to high-altitude hypoxic stress. In this review, we discuss the regulatory factors and intervention measures of pulmonary arterial hypertension induced by hypoxia from the aspects of hemodynamics of circulatory system, vasoactive state and changes of cardiopulmonary function.
Humans ; Altitude ; Arterial Pressure ; Acclimatization ; Hypoxia ; Muscle, Smooth

OBJECTIVE: To explore the feasibility of snuff pot arterial pressure measurement for patients undergoing routine elective surgery during anesthesia. METHODS: A prospective randomized controlled trial was conducted. Patients undergoing elective surgery admitted to the Handan Hospital of Traditional Chinese Medicine from June 1, 2020 to June 1, 2022 were enrolled. Patients who needed arterial pressure measurement for hemodynamic monitoring were randomly divided into routine radial artery puncture group and snuff pot artery puncture group with their informed consent. The patients in the routine radial artery puncture group were placed a catheter at the styloid process of the patient's radius to measure pressure. In the snuff pot artery puncture group, the snuff pot artery, that was, the radial fossa on the back of the hand (snuff box), was selected to conduct the snuff pot artery puncture and tube placement for pressure measurement. The indwelling time of arterial puncture catheter, arterial blood pressure, and complications of puncture catheterization of patients in the two groups were observed. Multivariate Logistic regression analysis was used to screen the relevant factors that affect the outcome of arterial catheterization. RESULTS: Finally, a total of 252 patients were enrolled, of which 130 patients received routine radial artery puncture and 122 patients received snuff pot artery puncture. There was no statistically significant difference in general information such as gender, age, body mass index (BMI), and surgical type of patients between the two groups. There was no significant difference in the indwelling time of artery puncture catheter between the routine radial artery puncture group and the snuff pot artery puncture group (minutes: 3.4±0.3 vs. 3.6±0.3, P > 0.05). The systolic blood pressure (SBP) and the diastolic blood pressure (DBP) measured in the snuff pot artery puncture group were significantly higher than those in the conventional radial artery puncture group [SBP (mmHg, 1 mmHg ≈ 0.133 kPa): 162.3±14.3 vs. 156.6±12.5, DBP (mmHg): 85.3±12.6 vs. 82.9±11.3, both P < 0.05]. There was no statistically significant difference in the incidence of complications such as arterial spasm, arterial occlusion, and pseudoaneurysm formation between the two groups. However, the incidence of hematoma formation in the snuff pot artery puncture group was significantly lower than that in the conventional radial artery puncture group (2.5% vs. 4.6%, P < 0.05). Based on the difficulty of arterial puncture, multivariate Logistic regression analysis showed that gender [odds ratio (OR) = 0.643, 95% confidence interval (95%CI) was 0.525-0.967], age (OR = 2.481, 95%CI was 1.442-4.268) and BMI (OR = 0.786, 95%CI was 0.570-0.825) were related factors that affect the outcome of arterial catheterization during anesthesia in patients undergoing elective surgery (all P < 0.05). CONCLUSIONS Catheterization through the snuff pot artery can be a new and feasible alternative to conventional arterial pressure measurement.
Humans ; Arterial Pressure/physiology* ; Feasibility Studies ; Radial Artery/physiology* ; Prospective Studies ; Tobacco, Smokeless ; Catheterization, Peripheral ; Punctures

OBJECTIVE: To compare well-known preload dynamic parameters intraoperatively including stroke volume variation (SVV), pulse pressure variation (PPV), and plethysmographic variability index (PVI) in children who underwent craniotomy for epileptogenic lesion excision. METHODS: A total of 30 children aged 0 to 14 years undergoing craniotomy for intracranial epileptogenic lesion excision were enrolled. During surgery, we measured PPV, SVV (measured by the Flotrac/Vigileo device), and PVI (measured by the Masimo Radical-7 monitor) simultaneously and continuously. Preload dynamic parameter measurements were collected at predefined steps: after induction of anesthesia, during opening the skull, intraoperative electroencephalogram monitoring, excision of epileptogenic lesion, skull closure, at the end of the operation. After exclusion of outliers, agreement among SVV, PPV, and PVI was assessed using repeated measures of Bland-Altman approach. The 4-quadrant and polar plot techniques were used to assess the trending ability among the changes in the three parameters. RESULTS: The mean SVV, PPV, and PVI were 8%±2%, 10%±3%, and 15%±7%, respectively during surgery. We analyzed a total of 834 paired measurements (3 to 8 data sets for each phase per patient). Repeated measures Bland-Altman analysis identified a bias of -2.3 and 95% confidence intervals between -1.9 and -2.7 (95% limits of agreement between -6.0 and 1.5) between PPV and SVV, showing significant correlation at all periods. The bias between PPV and PVI was -5.0 with 95% limits of agreement between -20.5 and 10.5, and that between SVV and PVI was -7.5 with 95% limits of agreement between -22.7 and 7.8, both not showing significant correlation. Reflected by 4-quadrant plots, the con-cordance rates showing the trending ability between the changes in PPV and SVV, PPV and PVI, SVV and PVI were 88.6%, 50.4%, and 50.1%, respectively. The concordance rate between PPV and SVV was higher (92.7%) in children aged less than 3 years compared with those aged 3 and more than 3 years. The mean angular bias, radial limits of agreement, and angular concordance rate in the polar analysis were not clinically acceptable in the changes between arterial pressure waveform-based parameters and volume-based PVI (PPV vs. PVI: angular mean bias 8.4°, angular concordance rate 29.9%; SVV vs. PVI: angular mean bias 2.4°, angular concordance rate 29.1%). There was a high concordance between the two arterial pressure waveform-based parameters reflected by the polar plot (angular mean bias -0.22°, angular concordance rate 86.6%). CONCLUSION PPV can be viewed as a surrogate for SVV, especially in children aged less than 3 years. The agreement between arterial pressure waveform-based preload parameters (PPV and SVV) and PVI is poor and these two should not be considered interchangeable. Attempt to combine PVI and PPV for improving the anesthesiologist's ability to monitor cardiac preload in major pediatric surgery is warranted.
Arterial Pressure ; Blood Pressure ; Child ; Craniotomy ; Humans ; Monitoring, Intraoperative ; Stroke Volume

arterial pressure (MAP), heart rate, end-tidal carbon dioxide, end-tidal sevoflurane and intraoperative infusion rates during surgery were calculated. Presence of intra-operative and post-operative bradycardia, tachycardia, hypotension, hypertension, hypothermia, hyperthermia was recorded. Time to endotracheal extubation, intraoperative occurrence of atrioventricular block, postoperative presence of agitation, seizures, use of labetalol and dexmedetomidine infusion were also recorded. Data from the two groups were compared with Fisher's exact test and unpaired t tests with Welch's correction. Odds ratio (OR) and 95% confidence interval (CI) were calculated for categorical variables. Intra-operatively, MAP was lower in Sevo-Op [85 (± 6.54) vs. 97.69 (± 7.8) mmHg, p = 0.0009]. Time to extubation was longer in Sevo-Dex [37.69 (10–70) vs. 19.63 (10–25), p = 0.0033]. No differences were found for the other intra-operative and post-operative variables investigated. Post-operative hypertension and agitation were the most common complications (11 and 12 out of 21 animals, respectively). These results suggest that the infusion of dexmedetomidine provides similar intra-operative conditions and post-operative course to a short acting opioid infusion during sevoflurane anesthesia in dogs undergoing elective rostrotentorial or transfrontal intracranial surgery.]]>
Airway Extubation ; Anesthesia ; Animals ; Arterial Pressure ; Atrioventricular Block ; Bradycardia ; Brain Neoplasms ; Carbon Dioxide ; Dexmedetomidine ; Dihydroergotamine ; Dogs ; Fever ; Heart Rate ; Hypertension ; Hypotension ; Hypothermia ; Labetalol ; Neurosurgery ; Observational Study ; Odds Ratio ; Retrospective Studies ; Seizures ; Tachycardia

The prevalence of cardiovascular disease in our country is increasing, and it has been a big problem affecting the social and economic development. It has been demonstrated that early intervention of cardiovascular risk factors can effectively reduce cardiovascular disease-caused mortality. Therefore, extensive implementation of cardiovascular testing and risk factor screening in the general population is the key to the prevention and treatment of cardiovascular disease. However, the categories of devices available for quick cardiovascular testing are limited, and in particular, many existing devices suffer from various technical problems, such as complex operation, unclear working principle, or large inter-individual variability in measurement accuracy, which lead to an overall low popularity and reliability of cardiovascular testing. In this study, we introduce the non-invasive measurement mechanisms and relevant technical progresses for several typical cardiovascular indices (e.g., peripheral/central arterial blood pressure, and arterial stiffness), with emphasis on describing the applications of biomechanical modeling and simulation in mechanism verification, analysis of influential factors, and technical improvement/innovation.
Arterial Pressure ; Biomechanical Phenomena ; Blood Pressure ; Blood Pressure Determination ; Humans ; Reproducibility of Results ; Risk Factors

INTRODUCTION: Balanced general anesthesia technique is a popular choice for induction because it can minimize potential side effects from individual drugs when otherwise used alone. However, hypotension is still a common occurrence during induction. Perfusion Index (PI) has been used as a measure of systemic vascular resistance and has shown to predict hypotension after regional anesthesia and propofol induction. This study aimed to determine whether baseline PI can predict hypotension following balanced general anesthesia induction and determine a cut-off value where hypotension is expected to occur. METHODS: Thirty-five ASA I/II adults for elective surgery under general anesthesia were enrolled. Heart rate, blood pressure and PI were measured every minute from baseline to 5 minutes following induction and 10 minutes after endotracheal intubation. Hypotension was defined as fall in systolic BP (SBP) by >30% of baseline and/or mean arterial pressure (MAP) to <60 mmHg. Severe hypotension (MAP of <55 mm Hg) was treated. RESULTS: No hypotension was observed in the first 5 minutes. Within 10 minutes, hypotension occurred in 8.6% by SBP criterion and 2.6% by MAP criterion. Within 15 minutes, hypotension was seen in 5.7% by SBP and MAP criterion, respectively. PI showed very low (r < 0.2) to low (r = 0.2 to 0.39), negative to positive and insignificant correlation (p > 0.05) with hypotension whether using SBP or MAP criterion and whether observed at 10 or 15 minutes of anesthesia induction. The Area under the ROC curve is 0.397, 95% CI [0 .126, 0.667], p = 0.431. CONCLUSION This study lends inconclusive evidence on the usefulness of Innovo Deluxe Fingertip Pulse Oximeter with Plethysmograph and Perfusion Index to predict intraoperative hypotension following balanced general anesthesia induction for this sample of patients. However, there was a positive, moderate (r=0.538, 0.501 and 0.469) and significant (p<0.05) correlation between perfusion index and SBP, Diastolic BP and MAP, respectively.
oximetry ; hypotension ; Anesthesia, General ; arterial pressure ; blood pressure ; Perfusion index

BACKGROUND: Controlled hypotension (CH) provides a better surgical environment and reduces operative time. However, there are some risks related to organ hypoperfusion. The EV1000/FloTrac system can provide continuous cardiac output monitoring without the insertion of pulmonary arterial catheter. The present study investigated the efficacy of this device in double jaw surgery under CH.METHODS: We retrospectively reviewed the medical records of patients who underwent double jaw surgery between 2010 and 2015. Patients were administered conventional general anesthesia with desflurane; CH was performed with remifentanil infusion and monitored with an invasive radial arterial pressure monitor or the EV1000/FloTrac system. We allocated the patients into two groups, namely an A-line group and an EV1000 group, according to the monitoring methods used, and the study variables were compared.RESULTS: Eighty-five patients were reviewed. The A-line group reported a higher number of failed CH (P = 0.005). A significant correlation was found between preoperative hemoglobin and intraoperative packed red blood cell transfusion (r = 0.525; P < 0.001). In the EV1000 group, the mean arterial pressure (MAP) was significantly lower 2 h after CH (P = 0.014), and the cardiac index significantly decreased 1 h after CH (P = 0.001) and 2 h after CH (P = 0.007). Moreover, venous oxygen saturation (ScVO2) decreased significantly at both 1 h (P = 0.002) and 2 h after CH (P = 0.029); however, these values were within normal limits.CONCLUSION: The EV1000 group reported a lower failure rate of CH than the A-line group. However, EV1000/FloTrac monitoring did not present with any specific advantage over the conventional arterial line monitoring when CH was performed with the same protocol and same mean blood pressure. Preoperative anemia treatment will be helpful to decrease intraoperative transfusion. Furthermore, ScVO2 monitoring did not present with sufficient benefits over the risk and cost.
Anemia ; Anesthesia, General ; Arterial Pressure ; Blood Pressure ; Cardiac Output ; Catheters ; Erythrocyte Transfusion ; Humans ; Hypotension, Controlled ; Medical Records ; Operative Time ; Orthognathic Surgery ; Osteotomy, Le Fort ; Oxygen ; Retrospective Studies ; Vascular Access Devices

When pericardial tamponade occurs to the left ventricular assist device (LVAD) implanted patients, typical hemodynamic signs of tamponade such as tachycardia and pulsus paradoxus may be masked by LVAD action. For those with normal heart, anesthetic management during pericardial tamponade operation before drainage is to restrict fluid administration and maintain perfusion pressure with vasopressor are recommended. But the things to concern are different in cases of patient with LVAD. Here, we describe a case of performing anesthesia with LVAD implanted patient for pericardial tamponade operation. A 58-year-old male with HeartWare™ (Medtronic, Framingham, MA, USA) LVAD implant was referred for cardiac tamponade surgery. After the induction of general anesthesia, his mean arterial pressure (MAP) decreased to 38 mmHg with device flow 1.8 L/min and device power 2.4 Watts at pump speed 2,400 RPM. Norepinephrine and Epinephrine infusion were initiated. MAP recovered to 70mmHg with device flow 3.7 L/min and power 3.0 Watts after the drainage of 1,200 cc of pericardial fluid. Cardiac tamponade with LVAD implanted patient present with decreased peak flow, mean flow and decreased pulsatility. LVAD flow depends on pump rotation, preload and afterload. In order to maintain flow in these patients, prevention of preload reduction is important. Since LVAD implantation becoming more popular as Bridge to transplantation and destination therapy, it is important for anesthesiologist to understand the LVAD parameters and factors that affect.
Anesthesia ; Anesthesia, General ; Arterial Pressure ; Cardiac Tamponade ; Drainage ; Epinephrine ; Heart ; Heart-Assist Devices ; Hemodynamics ; Humans ; Male ; Masks ; Middle Aged ; Norepinephrine ; Perfusion ; Pericardial Fluid ; Tachycardia

BACKGROUND: The supraglottic airway device is an appropriate alternative to tracheal intubation in laparoscopic surgery. We compared the Baska MaskⓇ with i-gelⓇ by measuring the oropharyngeal leak pressure (OLP) and hemodynamic and respiratory parameters during laparoscopic cholecystectomy.METHODS: A total of 97 patients were randomly allocated to either i-gel group (n = 49) or Baska Mask group (n = 48). Insertion time, number of insertion attempts, fiber-optic view of the glottis, and OLP were recorded. Heart rate, mean arterial pressure, peak airway pressure (PAP), lung compliance, and perioperative complications were assessed before, during, and after pneumoperitoneum.RESULTS: There were no significant differences between the two groups regarding demographic data, insertion time, fiber-optic view of the glottis, and the use of airway manipulation. The OLP was higher in the Baska Mask group than in the i-gel group (29.6 ± 6.8 cmH₂O and 26.7 ± 4.5 cmH₂O, respectively; P = 0.014). Heart rate, mean arterial pressure, PAP, and lung compliance were not significantly different between the groups. The incidence of perioperative complications was small and not statistically significant.CONCLUSIONS: Both the i-gel and Baska Mask provided a satisfactory airway during laparoscopic cholecystectomy. Compared with the i-gel, the Baska Mask demonstrated a higher OLP.
Arterial Pressure ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Glottis ; Heart Rate ; Hemodynamics ; Humans ; Incidence ; Intubation ; Laparoscopy ; Laryngeal Masks ; Lung Compliance ; Masks ; Pneumoperitoneum