Protocol for Determining Baseline Blood Pressure Prior to Cervical Decompression Surgery
Blood pressure should be measured in a standardized environment with calibrated equipment, with the patient seated, arm supported at heart level, after at least 5 minutes of rest, and multiple readings should be taken to establish an accurate baseline prior to cervical decompression surgery. 1
Standardized Measurement Setting
- Measure blood pressure in a relaxed, temperate environment using properly calibrated equipment 1
- Have the patient seated with their supported arm outstretched for at least one minute before taking the initial reading 1
- Ensure the patient has avoided caffeine, exercise, and smoking for at least 30 minutes before measurement 1
- Record pulse rate and rhythm before measuring blood pressure with a validated device 1
- Use auscultation over the brachial artery during manual deflation of an arm cuff if the pulse is irregular, as automated sphygmomanometers are inaccurate in this situation 1
Proper Measurement Technique
- Position the middle of the cuff on the patient's upper arm at the level of the right atrium (midpoint of the sternum) 1
- Use the correct cuff size, ensuring the bladder encircles 80% of the arm 1
- For auscultatory readings, use a palpated estimate of radial pulse obliteration pressure to estimate systolic blood pressure 1
- Inflate the cuff 20-30 mmHg above this level for an auscultatory determination 1
- Deflate the cuff at a rate of 2 mmHg per second while listening for Korotkoff sounds 1
Multiple Readings Protocol
- If the first measurement is ≥140/90 mmHg, take two additional readings at least one minute apart 1
- Record the lower of the last two readings 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, measure blood pressure in both arms 1
- If the difference between arms in systolic pressure is >20 mmHg, repeat the measurements and subsequently use the arm with the higher blood pressure 1
Interpretation and Documentation
- Document systolic and diastolic blood pressure readings both verbally and in writing 1
- Note the time of most recent blood pressure medication taken before measurements 1
- For readings between 140/90 mmHg and 179/109 mmHg, consider ambulatory (ABPM) or home blood pressure monitoring (HBPM) to establish true blood pressure 1
- For readings ≥180/110 mmHg, consider immediate treatment and possible postponement of non-urgent surgery 1
Special Considerations for Cervical Decompression Surgery
- Be aware that patients with cervical spondylotic myelopathy (CSM) may have associated hypertension that could improve after decompression surgery 2, 3
- Mean arterial blood pressure (MAP) at admission is a significant prognostic factor affecting recovery in cervical spinal cord injury patients 4
- Document baseline blood pressure thoroughly as it may be used for comparison in postoperative management 1
Preoperative Decision Making
- 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 1
- For patients with known hypertension, maintain their regular antihypertensive medications, as sudden withdrawal of certain agents (e.g., clonidine, alpha-methyldopa, beta-blockers) can be associated with adverse events 1
Common Pitfalls to Avoid
- Avoid taking measurements while the patient is sitting or lying on an examination table without proper back support and feet placement 1
- Avoid talking with the patient during the rest period or during the measurement 1
- Don't rely on a single blood pressure reading, especially if elevated 1
- Don't use an inappropriately sized cuff, as this can lead to inaccurate readings 1
- Be cautious about "white coat hypertension" - consider ambulatory or home monitoring if suspected 1