• Ilan Keidan, Avner Sidi, Erez Ben-Menachem, Yael Tene, and Haim Berkenstadt.
• Department of Anesthesiology and Intensive Care, Sheba Medical Center, Tel Hashomer,Israel (affiliated with Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel); Department of Anesthesiology, College of Medicine, University of Florida, Gainesville, FL 32610-0254, USA.
• J Clin Anesth. 2014 Feb 1;26(1):52-7.

Study ObjectiveTo determine the accuracy and precision of simultaneous noninvasive blood pressure (NIBP) measurement in the arm, forearm, and ankle in anesthetized children.DesignProspective, randomized study.SettingUniversity medical center.Patients101 ASA physical status 1 and 2 children (aged 1-8 yrs) scheduled for elective surgery with general anesthesia.MeasurementsSimultaneous NIBP measurements were recorded at the arm, forearm, and ankle at 5-minute intervals.Main ResultsThe systolic blood pressure difference between the arm-forearm or the arm-ankle was within the ± 10% range in 63% and 29% of measurements, and within the ± 20% range in 85% and 67% of measurements, respectively. The diastolic blood pressure difference between the arm-forearm or the arm-ankle was within the ± 10% range in 42% and 44% and within the ± 20% range in 67% and 74% of measurements, respectively. In patients in whom the initial three NIBP measurements were within the ± 20% range between the forearm and arm, 86% of the subsequent measurements were also within that limit.ConclusionsForearm and ankle NIBP measurements are unreliable and inconsistent with NIBP measured in the arm of anesthetized children. These alternative BP measurement sites are not reliable in accuracy (comparison with reference "gold" standard) and precision (reproducibility).Copyright © 2014 Elsevier Inc. All rights reserved.

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