Perioperative Blood Pressure Monitoring in Patients With Obesity

Victoria A. Eley, PhD; Rebecca Christensen, PhD; Louis Guy, MBBS; Benjamin Dodd, MSc

Disclosures

Anesth Analg. 2019;128(3):484-491. 

In This Article

Abstract and Introduction

Abstract

Blood pressure monitoring plays a key part in the preoperative, intraoperative, and postoperative care of all patients. In patients with obesity, hypertension indicates increased metabolic and surgical risk and may signal the presence of significant medical comorbidities, including obstructive sleep apnea. Avoidance of hypertension postoperatively is necessary to minimize bleeding risk after surgery. Hypotension in the postoperative period may be the first sign of significant complications that require urgent management. With the problem of being overweight or obese now affecting two-thirds of adults in Western countries, the proportion of patients with obesity in perioperative environments is similarly increasing. Detection of aberrations in blood pressure is contingent on the accuracy of blood pressure measurement methods. Patients with obesity tend to have a large arm circumference and "cone-shaped arms." Standard blood pressure cuffs fit such patients poorly, and this compromises the accuracy of measurements. Alternatives to arm blood pressure cuffs, some made specifically for individuals with obesity, have been evaluated but are not widely available to clinicians. This focused narrative review will discuss the relevance of hypertension management in the care of patients with obesity, highlight the currently available methods for perioperative monitoring of blood pressure, and explore the opportunities that exist to improve the perioperative blood pressure care in patients with obesity undergoing surgical procedures.

Introduction

Accurate blood pressure measurement is essential for the perioperative care of all patients, including those who are obese. Anesthetic care involves preoperative evaluation and optimization of the patient, followed by intraoperative delivery of anesthesia and monitoring of oxygenation, ventilation, and hemodynamic parameters. This close monitoring must continue postoperatively until complete recovery from anesthesia. Accordingly, accurate blood pressure measurement is considered essential throughout the perioperative period—however, the accuracy of standard blood pressure monitoring equipment is known to be compromised by obesity. Because adults who are overweight or obese comprise two-thirds of the population in Western countries, a significant number of patients are likely to have inadequate blood pressure monitoring during their perioperative care.

This article will discuss the relevance of blood pressure management in the care of patients with obesity, the currently available methods for perioperative monitoring of blood pressure and opportunities that exist to improve the perioperative blood pressure care in patients with obesity undergoing surgical procedures.

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