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Letters to the Editor: Letter to the Editor

The Accuracy of Perioperative Noninvasive Blood Pressure Monitoring in Obese Patients

Grocott, Hilary P. MD, FRCPC, FASE

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doi: 10.1213/ANE.0000000000002862
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To the Editor

The recent narrative review by Kuck and Baker1 addressing both oscillometric and other continuous noninvasive blood pressure (NIBP) monitoring techniques for this ubiquitously standard perioperative monitor2 addresses several factors that may impact NIBP accuracy. Although some additional details could arguably have been provided, the authors do mention that the shape of the upper extremity where the cuff is applied has an impact on NIBP accuracy by altering the profile of the pressure being applied to the artery that is being oscillometrically interrogated beneath the NIBP cuff. Indeed, obese patients with a more frequently conical-shaped arm are of particular concern; however, Anast et al3 have recently shown that irrespective of arm morphology, NIBP measurements are often inaccurate in the obese, implying that invasive blood pressure monitoring may be of more value. Because obesity is found in approximately one-third of adults in the United States,4 understanding the implications of obesity on NIBP monitoring seems particularly relevant to note.

Hilary P. Grocott, MD, FRCPC, FASE
Department of Anesthesia, Perioperative & Pain Medicine
University of Manitoba
Winnipeg, Manitoba, Canada
[email protected]


1. Kuck K, Baker PD. Perioperative noninvasive blood pressure monitoring. Anesth Analg. 2018;127:408–411.
2. Bartels K, Esper SA, Thiele RH. Blood pressure monitoring for the anesthesiologist: a practical review. Anesth Analg. 2016;122:1866–1879.
3. Anast N, Olejniczak M, Ingrande J, Brock-Utne J. The impact of blood pressure cuff location on the accuracy of noninvasive blood pressure measurements in obese patients: an observational study. Can J Anaesth. 2016;63:298–306.
4. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA. 2014;311:806–814.
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