Avaliação do desempenho de dois monitores oscilométricos portáteis na estimativa da pressão arterial direta em gatos anestesiados com isofluorano
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Data
2016-02-19
Autores
Cerejo, Sofia de Amorim [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
O desenvolvimento de monitores oscilométricos de pressão arterial (MOPA) que produzam resultados confiáveis é de grande importância em felinos domésticos. O objetivo deste estudo foi comparar o desempenho de dois MOPA com algoritmos específicos para a espécie felina (petMAPclassic e petMAPgraphic) na estimativa da pressão arterial invasiva (PAI), em um modelo experimental, com a realização de ovariohisterectomia ou orquiectomia eletiva no final do estudo. Oito gatos adultos sadios, duas fêmeas e seis machos (3,2 a 5,5 kg) foram pré-medicados pela via intramuscular com midazolam (0,2 mg/kg), cetamina (7 mg/kg) e metadona (0,1 mg/kg). A anestesia foi induzida com propofol e mantida com isoflurano sob ventilação mecânica. Durante a anestesia, os manguitos dos MOPA foram posicionados no membro torácico (MT) e na base da cauda, enquanto a PAI foi registrada a partir da artéria podal dorsal. Variações na pressão arterial média (PAM) invasiva entre aproximadamente 40 a 100 mmHg foram induzidas por meio de ajustes na concentração de isoflurano ao final da expiração e/ou nas taxas de infusão intravenosa de dopamina (n = 8), norepinefrina (n = 1) ou fenilefrina (n = 1). Em cada faixa de pressão estável (PAM invasiva oscilando em até ± 5 mmHg), três ou duas mensurações simultâneas entre os MOPA e a PAI foram obtidas com o manguito em cada posição. A concordância entre os métodos testados (MOPA) e o método de referência (PAI) foi analisada por meio do método de Bland-Altman para medidas repetidas no mesmo indivíduo; enquanto a capacidade dos métodos testados em rastrear tendências na PAI foi avaliada pela análise gráfica em quatro quadrantes. A média das diferenças ± limites de concordância [LDC: média das diferenças ± 1,96 vezes o desvio-padrão (DP)] (mmHg) registrados entre o petMAPclassic (MT) e a PAI para a pressão arterial sistólica (PAS), pressão arterial diastólica (PAD) e PAM foram de 4,2 ± 28,5, -6,1 ± 13,2 e -1,9 ± 14,6, respectivamente. A média das diferenças e LDC (mmHg) entre o petMAPclassic e a PAI com o manguito na cauda foram de 7,2 ± 31,3 (PAS), -6,1 ± 11,6 (PAD) e -1,1 ± 11,7 (PAM). A média das diferenças e LDC (mmHg) entre o petMAPgraphic (MT) e a PAI foram de 7,7 ± 27,0 (PAS), -4,3 ± 11,5 (PAD) e 0,2 ± 13,0 (PAM); enquanto os valores registrados por este monitor com o manguito na cauda foram de 10,9 ± 29,6 (PAS), -4,4 ± 11,7 (PAD) e -0,1 ± 12,1 (PAM). As taxas de concordância obtidas por meio dos gráficos em quatro quadrantes após excluir alterações na pressão arterial ≤ 5 mmHg foram ≥ 93% para ambos os aparelhos. Apesar de ambos os monitores fornecerem estimativas clinicamente inaceitáveis da PAS invasiva, os valores de PAM derivados do petMAPclassic e do petMAPgraphic e a PAD mensurada pelo petMAPgraphic resultaram em concordância clinicamente aceitável com o método de referência de acordo com a “Association for the Advancement of Medical Instrumentation”, a qual determina que a média das diferenças deve ser ≤ 5 mmHg com o DP ≤ 8 mmHg (ou LDC ≤ ± 16 mmHg). Ambos os monitores resultaram em capacidade aceitável de rastreamento de mudanças na PAS, PAD e PAM.
The development of oscillometric blood pressure (OBP) monitors that produce reliable results in feline patients is of great importance. The aim of this study was compare the performance of two species-specific OBP monitors (petMAPclassic and petMAPgraphic) for estimating invasive blood pressure (IBP) in anesthetized cats, in an experimental model, with the performance of elective ovariohysterectomy and orchiectomy at the end of the study. Eight healthy adult cats, 2 females and 4 males (3.2 to 5.5 kg), were premedicated with midazolam (0.2 mg/kg), ketamine (7 mg/kg) and methadone (0.1 mg/kg) administered intramuscularly. Anesthesia was induced with propofol and maintained with isoflurane under mechanical ventilation. During the anesthesia, OBP cuffs were placed on the thoracic limb and on the base of the tail while IBP was recorded from a dorsal pedal artery. Invasive mean arterial pressure (MAP) was changed between approximately 40 to 100 mmHg by means of adjustments in the end-tidal isoflurane concentrations and/or intravenous infusion rates of dopamine (n = 8), norepinephrine (n = 1), or phenylephrine (n = 1). For each steady state blood pressure condition (invasive MAP varying by < ± 5 mmHg) three to two measurements were recorded simultaneously with the OBP and IBP monitors, with the cuff in each position. Agreement between the tested (OBP) and the reference (IBP) methods was analyzed by the Bland-Altman method for multiple measures on the same individual; while the ability of OBP devices to track changes in IBP was analyzed by four quadrant plots. Mean biases ± limits of agreement [LOA: ± 1.96 times standard deviation (SD)] (mmHg) recorded between the petMAPclassic (thoracic limb) and IBP for systolic arterial pressure (SAP), diastolic arterial pressure (DAP), and MAP were 4.2 ± 28.5, -6.1 ± 13.2, and -1.9 ± 14.6, respectively; mean biases and LOA (mmHg) recorded with the tail cuff were 7.2 ± 31.3 (SAP), -6.1 ± 11.6 (DAP), and -1.1 ± 11.7 (MAP). Mean biases and LOA (mmHg) between petMAPgraphic (thoracic limb) and IBP were 7.7 ± 27.0 (SAP), -4.3 ± 11.5 (DAP), 0.2 ± 13.0 (MAP); values recorded with the tail cuff were 10.9 ± 29.6 (SAP), -4.4 ± 11.7 (DAP), and -0.1 ± 12.1 (MAP). Concordance rates analyzed by the four-quadrant plot after excluding arterial pressure changes ≤ 5 mmHg was ≥ 93% for both devices. Although both OBP monitors provide unacceptable SAP estimations, MAP values derived from petMAPclassic e do petMAPgraphic and DAP measured by the petMAPgraphic result in acceptable agreement with the reference method according to the Association for the Advancement of Medical Instrumentation, which states that the mean bias should be ≤ 5 mmHg with a SD of ≤ 8mmHg (or LOA ≤ ± 16 mmHg). Both monitors provide acceptable trending ability for SAP, DAP, and MAP.
The development of oscillometric blood pressure (OBP) monitors that produce reliable results in feline patients is of great importance. The aim of this study was compare the performance of two species-specific OBP monitors (petMAPclassic and petMAPgraphic) for estimating invasive blood pressure (IBP) in anesthetized cats, in an experimental model, with the performance of elective ovariohysterectomy and orchiectomy at the end of the study. Eight healthy adult cats, 2 females and 4 males (3.2 to 5.5 kg), were premedicated with midazolam (0.2 mg/kg), ketamine (7 mg/kg) and methadone (0.1 mg/kg) administered intramuscularly. Anesthesia was induced with propofol and maintained with isoflurane under mechanical ventilation. During the anesthesia, OBP cuffs were placed on the thoracic limb and on the base of the tail while IBP was recorded from a dorsal pedal artery. Invasive mean arterial pressure (MAP) was changed between approximately 40 to 100 mmHg by means of adjustments in the end-tidal isoflurane concentrations and/or intravenous infusion rates of dopamine (n = 8), norepinephrine (n = 1), or phenylephrine (n = 1). For each steady state blood pressure condition (invasive MAP varying by < ± 5 mmHg) three to two measurements were recorded simultaneously with the OBP and IBP monitors, with the cuff in each position. Agreement between the tested (OBP) and the reference (IBP) methods was analyzed by the Bland-Altman method for multiple measures on the same individual; while the ability of OBP devices to track changes in IBP was analyzed by four quadrant plots. Mean biases ± limits of agreement [LOA: ± 1.96 times standard deviation (SD)] (mmHg) recorded between the petMAPclassic (thoracic limb) and IBP for systolic arterial pressure (SAP), diastolic arterial pressure (DAP), and MAP were 4.2 ± 28.5, -6.1 ± 13.2, and -1.9 ± 14.6, respectively; mean biases and LOA (mmHg) recorded with the tail cuff were 7.2 ± 31.3 (SAP), -6.1 ± 11.6 (DAP), and -1.1 ± 11.7 (MAP). Mean biases and LOA (mmHg) between petMAPgraphic (thoracic limb) and IBP were 7.7 ± 27.0 (SAP), -4.3 ± 11.5 (DAP), 0.2 ± 13.0 (MAP); values recorded with the tail cuff were 10.9 ± 29.6 (SAP), -4.4 ± 11.7 (DAP), and -0.1 ± 12.1 (MAP). Concordance rates analyzed by the four-quadrant plot after excluding arterial pressure changes ≤ 5 mmHg was ≥ 93% for both devices. Although both OBP monitors provide unacceptable SAP estimations, MAP values derived from petMAPclassic e do petMAPgraphic and DAP measured by the petMAPgraphic result in acceptable agreement with the reference method according to the Association for the Advancement of Medical Instrumentation, which states that the mean bias should be ≤ 5 mmHg with a SD of ≤ 8mmHg (or LOA ≤ ± 16 mmHg). Both monitors provide acceptable trending ability for SAP, DAP, and MAP.
Descrição
Palavras-chave
Anestesia, Felinos, Monitoração, Pressão não invasiva, Anesthesia, Feline, Monitoring, Non-invasive pressure