Abstract
Objective. Shivering may occur in 75% of women undergoing spinal anesthesia for cesarean delivery and may render an automated noninvasive blood pressure (ANIBP) device incapable of determining blood pressure (BP). When patients shiver under spinal anesthesia, the lower extremities do not exhibit the same involuntary muscle movements as do the upper extremities. This study was undertaken to determine if a correlation exists between ANIBP measurements in the arm and calf of women undergoing cesarean delivery under spinal anesthesia. Methods. We enrolled 73 women in this blinded, prospective study. Simultaneous arm and calf BP were measured with an ANIBP and differences between the two were determined. Results. We found significant differences between the average difference in systolic and in diastolic BP, no significant difference between the average mean BP, and a tendency for the systolic BP to be higher and the diastolic BP to be lower in the calf than in the arm; however, there was a large degree of variability among patients. Conclusion. We conclude that there is a poor correlation between the BP measured by an ANIBP on the calf and one on the arm. In the parturient undergoing cesarean section, lower extremity BP as measured by an ANIBP does not correlate with the arm ANIBP and should not be used to assure fetal wellbeing.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
REFERENCES
Shnider SM, deLorimier AA, Holl JW, Chaper FK, Morishima HO. Vasopressors in obstetrics. Am J Obstet Gynecol 1968; 102: 911–919
Zilanti M, Salazar JR, Aller J, Aguero O. Fetal heart rate and pH of fetal Capillary blood during epidural analgesia in labor. Obstet and Gynecol 1970; 36: 881–886
Moya F, Smith B. Spinal anesthesia for cesarean section: Clinical and biochemical studies of effects on maternal physiology. JAMA 1962; 179: 609–614
Greiss FC, Crandell DL. Therapy for hypotension induced by spinal anesthesia during pregnancy. JAMA 1965; 191: 89–92
Brizgys RV, Daily PA, Shnider SM, Kotelko DM, Levinson G. The incidence and neonatal effects of maternal hypotension during epidural anesthesia for cesarean section. Anesthesiology 1987; 67: 782–786
Clark RB, Thompson DS, Thompson CH. Prevention of spinal hypotension with cesarean section. Anesthesiology 1976; 45: 670–674
Webb PJ, James FM, Wheeler AS. Shivering during epidural analgesia in women in labor. Anesthesiology 1981; 55: 706–707
Ramsey M. Automatic oscillometric NIBP versus manual auscultatory blood pressure in the PACU. J Clin Monit Comput 1994; 10: 136–139
Paulus DA. Noninvasive blood pressure measurement. Med Instrum 1981; 15: 91–94
Maier WR. Noninvasive Blood Pressure Monitoring. In: Blitt CD, ed. Monitoring in Anesthesia and Critical Care Medicine 2nd edition. New York: Churchill Livingstone, 1990: 84
Altman DG, Bland JM. Statistical methods for assessing agreement between two methods of clinical measurement. The Lancet 1986; 8476: 307–310
Functional Descriptions of M1046-93016. In: HP Component Monitoring System Service Manual. Vol I, edition 5, section 8, 1996: 1–7
Van Bergen FH, Weatherhead DS, Treloar AE, Dobkin AB, Buckley JJ. Comparison of direct and indirect methods of measuring arterial blood pressure. Circulation 1954; 10: 481–490
Ramsey M. Noninvasive automatic determination of mean arterial pressure. Med Biol Eng Comput 1979; 17: 11–18
Milsom I, Svahn SO, Forssman L, Sivertsson R. An evaluation of automated indirect blood pressure measurement during pregnancy. Acta Obstet Gynecol Scand 1986; 65: 721–725
Park MK, Lee DH, Johnson GA. Oscillometric blood pressures in the arm, thigh, and calf in healthy children and those with aortic coarctation. Pediatrics 1993; 91: 761–765
Block FE, Schulte GT. Ankle blood pressure measurement, an acceptable alternative to arm measurement. Int Clin Monit Comput 1996; 13: 167–171
Hui YL, Wu YW. The blood pressure of upper and lower extremities in parturients under spinal anesthesia for cesarean section. Acta Anaesthesiol Sin 1995; 33: 119–122
Berne RM, Levy MN, The Arterial System. In: Berne RM, Levy MN, eds. Physiology, 3rd ed. St. Louis: Mosby, 1993: 462–463
Bieniarz J, Maqueda E, Caldeyro-Barcia R. Compression of aorta by the uterus in late human pregnancy. I. Variations between femoral and brachial artery pressure with changes from hypertension to hypotension. Am J Obstet Gynecol 1966; 95: 795–808
Eckstein KL, Marx GF. Aortocaval compression and uterine displacement. Anesthesiology 1974; 40: 92–96
Hon EH, Reid BL, Hehre FW. The electronic evaluation of fetal heart rate. Am J Obstet Gynecol 1960; 79: 209–215
Norris MC. Spinal Anesthesia for Cesarean Delivery. In: Norris MC, ed. Obstetric Anesthesia, 2nd edition. Philadelphia: Lippincott Williams Wilkins, 1999: 415–439
Shnider SM, Levinson G. Anesthesia for Cesarean Section. In: Shnider SM, Levinson G, eds. Anesthesia for Obstetrics, 3rd edition. Baltimore: Williams Wilkins, 1993: 211–245
Reisner LS, Lin D. Anesthesia for Cesarean Section. In: Chestnut DH, ed. Obstetric Ansesthesia: Principles and Practice. St. Louis: Mosby, 1994: 459–486
Corke BC, Datta SJ, Ostheimer GW, Weiss JB, Alper MH. Spinal anesthesia for caesarean section: The influence of hypotension on neonatal outcome. Anaesthesia 1982; 37: 658
Ebner H, Barcohana J, Bartoshuk AK. Influence of postspinal hypotension on the fetal electrocardiogram. Am J Obstet Gynecol 1960; 80: 569–572
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Zahn, J., Bernstein, H., Hossain, S. et al. Comparison of Non-invasive Blood Pressure Measurements on the Arm and Calf During Cesarean Delivery. J Clin Monit Comput 16, 557–562 (2000). https://doi.org/10.1023/A:1012267312308
Issue Date:
DOI: https://doi.org/10.1023/A:1012267312308