• Alberto Noto, Filippo Sanfilippo, Giovanni De Salvo, Claudia Crimi, Filippo Benedetto, Ximena Watson, Maurizio Cecconi, and Antonio David.
• From the IPCF-CNR, Institute for Chemical and Physical Processes, Messina (AN), Department of Anaesthesia and Intensive Care, AOU G.Martino, University of Messina, Messina (AN, GDS, AD), Department of Anaesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo (FS), Department of Respiratory Medicine, AOU 'Policlinico-Vittorio Emanuele', University of Catania, Catania (CC), Department of Vascular Surgery, AOU G. Martino, University of Messina, Messina, Italy (FB), Department of Anaesthesia and Intensive Care, St Helier and Epsom Hospital (XW) and Department of Intensive Care Medicine, St George's University Hospital NHS Foundation Trust, London, UK (MC).
• Eur J Anaesthesiol. 2019 Feb 1; 36 (2): 144-152.

BackgroundContinuous noninvasive blood pressure (CNBP) measurement using the volume-clamp method is a less invasive alternative compared with invasive intra-arterial monitoring for awake patients during carotid endarterectomy (CEA) under regional anaesthesia.ObjectiveWe investigated the agreement of blood pressure (BP) recorded with invasive and CNBP methods during awake CEA.DesignA prospective observational study for assessing agreement with Bland-Altman plots, agreement-tolerability indices (ATI), concordance and interchangeability.SettingAzienda Ospedaliera Universitaria G. Martino, Messina, a University tertiary referral centre in Italy.PatientsIn 30 consecutive patients, we recorded continuously ipsilateral invasive and noninvasive BPs, from 3 min before carotid cross-clamping to 5 min after unclamping.Main Outcome MeasuresPrimary outcome was bias, 95% limits of agreement, ATI, concordance and interchangeability for mean arterial pressure (MAP). Secondary outcomes were agreements for systolic arterial pressure and diastolic arterial pressure. Tracking of changes was assessed with four-quadrant polar plots and the trend interchangeability method. Optimal bias was defined as 5 mmHg or less.ResultsA total of 2672 invasive and CNBP paired measurements (93% of overall data) were analysed, with a median of 92 readings per patient [IQR 76 to 100]. Mean (SD) bias for MAP, systolic arterial pressure and DAP were -6.8 (6.7), -3.0 (9.7) and -9.0 (5.4) mmHg, respectively. The ATIs were 0.88, 0.95 and 0.71, respectively, where ATI of 1.0 or less and at least 2.0 defined acceptable, marginal and unacceptable agreements. The four-quadrant plot analysis for beat-to-beat differences showed concordance rates of 97.3%, 99.98% and 96.4%, respectively. Polar plot analysis showed 95% limits of agreement of -3 to 3, -2 to 2 and -2 to 2 mmHg respectively. Trend interchangeability method showed an interchangeability rate of 95% for MAP.ConclusionDuring CEA performed under regional anaesthesia, CNBP offers a less invasive approach for BP monitoring. We found acceptable agreement for MAP defined by an ATI of 0.88 and an excellent 95% global interchangeability rate. A suboptimal bias of 7 mmHg was found with CNBP for MAP.

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