Effects of cuff size and position on the agreement between arterial blood pressure measured by Doppler ultrasound and through a dorsal pedal artery catheter in anesthetized cats

Objective: To compare the effects of cuff size/position on the agreement between arterial blood pressure measured by Doppler ultrasound (ABP_Doppler) and dorsal pedal artery catheter measurements of systolic (SAP_invasive) and mean arterial pressure (MAP_invasive) in anesthetized cats.

Study design: Prospective study.

Animals: A total of eight cats (3.0-3.8 kg) for neutering.

Methods: During isoflurane anesthesia, before surgery, changes in end-tidal isoflurane concentrations and/or administration of dopamine were performed to achieve SAP_invasive within 60-150 mmHg. Cuff sizes 1, 2 and 3 (bladder width: 20, 25 and 35 mm, respectively) were placed on distal third of the antebrachium, above the tarsus and below the tarsus for ABP_Doppler measurements. Agreement between ABP_Doppler and SAP_invasive or between ABP_Doppler and MAP_invasive was compared with reference standards for noninvasive blood pressure devices used in humans and small animals.

Results: Mean bias and precision (±standard deviation) between ABP_Doppler and SAP_invasive met veterinary standards (≤10 ± 15 mmHg), but not human standards (≤5 ± 8 mmHg), with cuffs 1 and 2 placed on the thoracic limb (7.4 ± 13.9 and -5.8 ± 9.5 mmHg, respectively), and with cuff 2 placed proximal to the tarsus (7.2 ± 12.4 mmHg). Cuff width-to-limb circumference ratios resulting in acceptable agreement between ABP_Doppler and SAP_invasive were 0.31 ± 0.04 (cuff 1) and 0.42 ± 0.05 (cuff 2) on the thoracic limb, and 0.43 ± 0.05 (cuff 2) above the tarsus. ABP_Doppler showed no acceptable agreement with MAP_invasive by any reference standard.

Conclusions and clinical relevance: The agreement between ABP_Doppler and SAP_invasive can be optimized by placing the occlusive cuff on the distal third of the antebrachium and above the tarsus. In these locations, cuff width should approach 40% of limb circumference to provide clinically acceptable estimations of SAP_invasive. Doppler ultrasound cannot be used to estimate MAP_invasive in cats.