Protocol for Determining Baseline Blood Pressure Prior to Cervical Decompression Surgery

Standardized Measurement Setting

The American Society of Anesthesiologists recommends measuring blood pressure in a relaxed, temperate environment using properly calibrated equipment 1
Patients should be seated with their supported arm outstretched for at least one minute before taking the initial reading 1
The American Heart Association suggests ensuring the patient has avoided caffeine, exercise, and smoking for at least 30 minutes before measurement 3
Pulse rate and rhythm should be recorded before measuring blood pressure with a validated device 1
Auscultation over the brachial artery during manual deflation of an arm cuff is recommended if the pulse is irregular, as automated sphygmomanometers are inaccurate in this situation 1

The American College of Cardiology recommends positioning the middle of the cuff on the patient's upper arm at the level of the right atrium 3
The correct cuff size should be used, ensuring the bladder encircles 80% of the arm 3
For auscultatory readings, a palpated estimate of radial pulse obliteration pressure can be used to estimate systolic blood pressure 3
The cuff should be inflated 20-30 mmHg above this level for an auscultatory determination 3
The cuff should be deflated at a rate of 2 mmHg per second while listening for Korotkoff sounds 3

If the first measurement is ≥140/90 mmHg, two additional readings should be taken at least one minute apart 1
The lower of the last two readings should be recorded as the blood pressure 1
If the reading is <140/90 mmHg, the patient is considered normotensive 1
For patients scheduled for vascular or renal surgery, blood pressure should be measured in both arms 1
If the difference between arms in systolic pressure is >20 mmHg, the measurements should be repeated and the arm with the higher blood pressure used 1

Systolic and diastolic blood pressure readings should be documented both verbally and in writing 3
The time of most recent blood pressure medication taken before measurements should be noted 3
For readings between 140/90 mmHg and 179/109 mmHg, ambulatory or home blood pressure monitoring should be considered to establish true blood pressure 1
For readings ≥180/110 mmHg, immediate treatment and possible postponement of non-urgent surgery should be considered 1 2

Baseline blood pressure should be documented thoroughly as it may be used for comparison in postoperative management 4

Blood pressures <180 mmHg systolic and <110 mmHg diastolic in secondary care should not preclude elective surgery 1
If blood pressure is ≥180/110 mmHg, the patient should return to their general practice for primary care assessment and management before non-urgent surgery 5
For patients with known hypertension, regular antihypertensive medications should be maintained, as sudden withdrawal of certain agents can be associated with adverse events 2

Measurements should not be taken while the patient is sitting or lying on an examination table without proper back support and feet placement 3
Talking with the patient during the rest period or during the measurement should be avoided 3
A single blood pressure reading should not be relied upon, especially if elevated 1
An inappropriately sized cuff should not be used, as this can lead to inaccurate readings 3
"White coat hypertension" should be considered, and ambulatory or home monitoring used if suspected 1