Episode #263 Blood Pressure Blind Spots

Hello and welcome back to the Anesthesia Patient Safety Podcast. My name is Alli Bechtel, and I am your host. Thank you for joining us for another show. The APSF is bringing you the latest in perioperative patient safety and today we have a special show for you. We are going to be tuning into the recent Capitol Hill Briefing on Enhancing Patient Safety with Continuous Blood Pressure Monitoring. This represents a campaign to reduce surgical harm from intraoperative hypotension. Anesthesia Professionals are charged with monitoring circulation and blood pressure during surgery and anesthesia care and there are serious complications associated with intraoperative hypotension, so we need to remain vigilant. Check out episodes #70 and #219 on this podcast where we talk about intraoperative hypotension and the associated threats to anesthesia patient safety. Our show today focuses on the important issues of continuous blood pressure monitoring, intraoperative hypotension, and maternal morbidity and mortality.

Before we dive further into the episode today, we’d like to recognize Solventum, a major corporate supporter of APSF. Solventum has generously provided unrestricted support to further our vision that “no one shall be harmed by anesthesia care”. Thank you, Solventum– we wouldn’t be able to do all that we do without you!”

Our featured resource today is the recording of the livestream of the briefing on Capitol Hill with members of congress, healthcare professionals, and patient safety advocates that took place on June 10, 2025. This briefing covers the urgent need to safeguard patients through continuous blood pressure monitoring during surgery. There is a bipartisan representation on the panel which highlights the public health and patient safety implications of dangerously low blood pressure and the need for an updated standard of care for blood pressure monitoring. To follow along with us, head over to ASPF.org and click on the Patient Safety Resources Heading. The third one down is Continuous Blood Pressure Monitoring. I will include the link in the show notes as well.

We are going to be tuning into the livestream later in the show, but first let’s take a quick look at this resource.

We’ll start with the big picture. Why does this matter? Did you know that each year, 1 in 9 people in the United States undergo a surgical procedure. Did you also know that the majority of these patients, 88% of them, experience some level of hypotension during surgery. Intraoperative hypotension is associated with serious complications including kidney injury, heart damage, stroke, longer hospital stays, and mortality. These are all serious complications that can be mitigated through timely detection and intervention.

Intraoperative hypotension is a big threat to anesthesia patient safety. The problem comes from monitoring…or rather lack of monitoring. Our standard non-invasive intermittent oscillometric blood pressure arm cuffs are the minimal standard for monitoring during surgery. This monitor provides a blood pressure every few minutes, but fails to provide continuous blood pressure monitoring and as a result, we can miss rapid drops in blood pressure. This is something that may occur during any procedure and with all patients during surgery and anesthesia care. Studies have shown the following:

• One third of patients experience more than 15 minutes of dangerously low blood pressure
• It is more common in younger, healthier patients undergoing “routine” procedures
• Arm cuffs can misclassify up to 50% of hypotensive readings as normal, putting patients at unrecognized risk

Now we know that intraoperative hypotension is a big problem and this has important maternal health implications especially during caesarean deliveries. Rapid decreases in blood pressure are common and dangerous for the mom and baby. Key concerns include:

• Low blood pressure (hypotension) during and after caesarean delivery can signal serious issues like haemorrhage or sepsis
• Maternal hypotension during c-section can lead to nausea, vomiting, unconsciousness, and poor placental perfusion – which can put the baby at risk
• For newborns, it can result in fetal acidosis and poor neurological function, due to reduced oxygen delivery
• Obstetric anesthesiologists increasingly recognize the need for continuous monitoring to stabilize maternal hemodynamic and improve safety for both mother and baby

Continuous blood pressure monitoring provides real-time data that allows anaesthesia professionals to respond immediately to hypotensive events or even down-trending blood pressures rather than waiting for the next intermittent cuff reading. This is a way to eliminate these blind spots between readings to help improve patient safety. There have been important technological advances in continuous blood pressure monitoring including non-invasive finger-cuffs that provide real-time measurement of blood pressure. The benefits of these non-invasive continuous blood pressure monitors is earlier detection of hypotension, decreased severity and duration of intraoperative hypotension, and decreased reliance on invasive arterial lines. In addition, these new devices have been shown to be as accurate as invasive methods in clinical trials.

So, what do that experts and medical societies have to say about all of this? Here are some of the recommendations from around the world.

• Anesthesia Patient Safety Foundation (APSF) recommends accelerating the adoption and integration of continuous non-invasive monitoring
• The Perioperative Quality Initiative (POQI) concludes that there is high quality evidence that continuous blood pressure monitoring helps reduce the severity and duration of hypotension compared to intermittent monitoring
• The German Society of Anesthesiology and Intensive Care Medicine recommends that continuous blood pressure monitoring, via invasive or non-invasive methods, should be used in patients at risk of blood pressure-related complications to enable real-time detection and management of hypotension or hypertension.

There is a call to action to support non-invasive blood pressure monitoring during every surgery. Remember, intraoperative hypotension is common even in low-risk surgeries and increases the risk of serious complications. Our current standard intermittent cuff monitoring may miss intraoperative hypotension. We have a better option available since continuous non-invasive monitoring has been shown to reduce intraoperative hypotension and improve patient safety.

We started with the highlights, but now it’s time to hear all the details. Let’s take a listen to the Capitol Hill Briefing on Enhancing Patient Safety with Continuous Blood Pressure Monitoring.

[Insert Livestream here]

If you have any questions or comments from today’s show, please email us at [email protected]. Please keep in mind that the information in this show is provided for informational purposes only and does not constitute medical or legal advice. We hope that you will visit APSF.org for detailed information and check out the show notes for links to all the topics we discussed today.

If you were inspired by the capitol hill briefing and this podcast, we want to make sure that you don’t miss out on the latest updates. By providing your email on the Continuous Blood Pressure Monitoring resource page, we will make sure that you receive regular updates about the benefits of continuous blood pressure monitoring and the continuing discussion about standard of care. You can be a Continuous Blood Pressure monitoring champion at your institution as you work to improve anesthesia patient safety.

Until next time, stay vigilant so that no one shall be harmed by anesthesia care.

© 2025, The Anesthesia Patient Safety Foundation