Agreement of high-definition oscillometry at two cuff locations with invasively measured arterial blood pressures in anaesthetised cheetahs

Published:November 25, 2022DOI:



      To evaluate the agreement between high-definition oscillometry (HDO) used on the metatarsus or tail base with invasive arterial blood pressures measured in the dorsal pedal artery in anaesthetised cheetahs.

      Study Design

      Prospective clinical study.


      A group of 13 captive adult cheetahs.


      Cheetahs were immobilised with medetomidine (32–45 μg kg–1) and tiletamine/zolazepam (0.93–1.39 mg kg–1) administered intramuscularly, and anaesthesia was maintained with either isoflurane in oxygen or continuous propofol infusion. Invasive blood pressure was measured via a 20 gauge intra-arterial catheter in the dorsal pedal artery in the metatarsus and used as a reference method for pressures simultaneously estimated using HDO on the contralateral metatarsus and tail base. Bland–Altman plots (for repeated measurements) and criteria defined by the American College of Veterinary Internal Medicine (ACVIM) were used to compare agreement according to the anatomical location of the cuff, the anaesthetic maintenance agent and magnitude of the blood pressure.


      A total of 147 paired measurements were obtained with HDO on the metatarsus and 135 on the tail. Agreement with invasive pressures was better when HDO was used on the tail (rather than on the metatarsus) with all ACVIM criteria being met. Mean bias (a positive bias meaning that HDO overestimated the invasively measured pressures) ± standard deviation of differences for systolic, diastolic and mean arterial pressures were –7.0 ± 13.9, 4.2 ±12.1 and 4.6 ±11.2 mmHg, respectively, for HDO on the tail, and –11.9 ±15.1, 2.8 ±16.5 and 2.1 ±13.2 mmHg, respectively, for HDO on the metatarsus. Agreement was better during isoflurane anaesthesia than propofol, and at lower blood pressures than at higher.

      Conclusions and clinical relevance

      When used on the tail base of anaesthetised cheetahs, HDO met the ACVIM validation criteria for a noninvasive device, as compared to invasively measured pressures in the dorsal pedal artery.


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        • Acierno M.J.
        • Brown S.
        • Coleman A.E.
        • et al.
        ACVIM consensus statement: guidelines for the identification, evaluation, and management of systemic hypertension in dogs and cats.
        J Vet Intern Med. 2018; 32: 1803-1822
        • American National Standards
        ANSI/AAMI SP10:2002/(R)2008 Manual, Electronic or Automated Sphygmomanometers.
        Association for the Advancement of Medical Instrumentation, USA2008
        • Bland J.M.
        • Altman D.G.
        Statistical methods for assessing agreement between two methods of clinical measurement.
        Lancet. 1986; 1: 307-310
        • Bland J.M.
        • Altman D.G.
        Agreement between methods of measurement with multiple observations per individual.
        J Biopharm Stat. 2007; 17: 571-582
        • Brown S.
        • Atkins C.
        • Bagley R.
        • et al.
        Guidelines for the identification, evaluation, and management of systemic hypertension in dogs and cats.
        J Vet Intern Med. 2007; 21: 542-558
        • Buck R.K.
        • Tordiffe A.S.W.
        • Zeiler G.E.
        Cardiopulmonary effects of anaesthesia maintained by propofol infusion versus isoflurane inhalation in cheetahs (Acinonyx jubatus).
        Vet Anaesth Analg. 2017; 44: 1363-1372
        • Carkeet A.
        Exact parametric confidence intervals for Bland–Altman limits of agreement.
        Optom Vis Sci. 2015; 92: e71-e80
        • Chetboul V.
        • Tissier R.
        • Gouni V.
        • et al.
        Comparison of Doppler ultrasonography and high-definition oscillometry for blood pressure measurements in healthy awake dogs.
        Am J Vet Res. 2010; 71: 766-772
        • Clark C.E.
        • Campbell J.L.
        • Evans P.H.
        • et al.
        Prevalence and clinical implications of the inter-arm blood pressure difference: a systematic review.
        J Hum Hypertens. 2006; 20: 923-931
        • da Cunha A.F.
        • Ramos S.J.
        • Domingues M.
        • et al.
        Agreement between two oscillometric blood pressure technologies and invasively measured arterial pressure in the dog.
        Vet Anaesth Analg. 2016; 43: 199-203
        • da Cunha A.F.
        • Ramos S.J.
        • Domingues M.
        • et al.
        Validation of noninvasive blood pressure equipment: which peripheral artery is best for comparison studies in dogs?.
        Vet Anaesth Analg. 2017; 44: 1068-1075
        • Davis P.D.
        • Parbrook G.
        • Kenny G.N.
        Fluid flow.
        in: Davis P. Parbrook G. Kenny G. Basic Physics and Measurement in Anaesthesia. 5th edn. Butterworth-Heinemann, USA2003: 11-22
        • Deem S.
        • Ko J.C.H.
        • Citino S.B.
        Anesthetic and cardiorespiratory effects of tiletamine-zolazepam-medetomidine in cheetahs.
        J Am Vet Med Assoc. 1998; 213: 1022-1026
        • Deryck Y.L.J.M.
        • Brimioulle S.
        • Maggiorini M.
        • et al.
        Systemic vascular effects of isoflurane versus propofol anesthesia in dogs.
        Anesth Analg. 1996; 83: 958-964
        • Duke-Novakovski T.
        • Ambros B.
        • Feng C.
        • et al.
        The effect of anesthetic drug choice on accuracy of high-definition oscillometry in laterally recumbent horses.
        Vet Anaesth Analg. 2017; 44: 589-593
        • Durant S.
        • Mitchell N.
        • Ipavec A.
        • et al.
        Acinonyx jubatus. The IUCN Red List of Threatened Species.
        Date accessed: March 26, 2020
        • Egner B.
        High definition oscillometry: non-invasive blood pressure measurement and pulse wave analysis.
        in: Pugsley M.K. Curtis M.J. Principles of Safety Pharmacology, Handbook of Experimental Pharmacology. Springer, Berlin2015: 243-264
        • Egner B.
        • Carr A.
        • Brown S.
        Essential Facts of Blood Pressure in Dogs and Cats: A Reference Guide.
        VetVerlag VBS, Germany2007
        • Garofalo N.A.
        • Teixeira Neto F.J.
        • Alvaides R.K.
        • et al.
        Agreement between direct, oscillometric and Doppler ultrasound blood pressures using three different cuff positions in anesthetized dogs.
        Vet Anaesth Analg. 2012; 39: 324-334
        • Grimm K.A.
        • Lamont L.A.
        Clinical pharmacology.
        in: West G. Heard D. Caulkett N. Zoo Animal and Wildlife Immobilization and Anesthesia. 1st edn. Blackwell Publishing, UK2007: 3-36
        • Grubb T.
        • Sager J.
        • Gaynor J.S.
        • et al.
        2020 AAHA Anesthesia and monitoring guidelines for dogs and cats.
        J Am Anim Hosp Assoc. 2020; 56: 59-82
        • Heard D.
        in: West G. Heard D. Caulkett N. Zoo Animal and Wildlife Immobilization and Anesthesia. 1st edn. Blackwell Publishing, UK2007: 83-91
        • Keegen R.D.
        • Greene S.A.
        Cardiovascular effects of a continuous two-hour propofol infusion in dogs: comparison with isoflurane anesthesia.
        Vet Surg. 1993; 22: 537-543
        • Kleinschmidt L.M.
        • Kinney M.E.
        • Camilo G.R.
        • et al.
        Comparison of propofol constant rate infusion and isoflurane for maintenance of anesthesia in Speke’s Gazelle, Gazella spekei.
        J Zoo Wildl Med. 2018; 49: 722-731
        • Kroeker E.J.
        • Wood E.H.
        Comparison of simultaneously recorded central and peripheral arterial pressure pulses during rest, exercise and tilted position in man.
        Circ Res. 1955; 3: 623-632
        • Marker L.L.
        Aspects of cheetah (Acinonyx jubatus) biology, ecology and conservation strategies on Namibian farmlands.
        (PhD thesis) Oxford University, UK2002
        • Munson L.
        Diseases of captive cheetahs (Acinonyx jubatus): Results of the cheetah research council pathology survey, 1989–1992.
        Zoo Biol. 1993; 12: 105-124
        • Munson L.
        • Nesbit J.W.
        • Meltzer D.G.A.
        • et al.
        Diseases of captive cheetahs (Acinonyx jubatus jubatus) in South Africa: a 20-year retrospective survey.
        J Zoo Wildl Med. 1999; 30: 342-347
        • Ogedegbe G.
        • Pickering T.
        Principles and techniques of blood pressure measurement.
        Cardiol Clin. 2010; 28: 571-586
        • R Core Team
        R: A Language and Environment for Statistical Computing.
        R Foundation for Statistical Computing, Vienna, Austria2021
        • Rysnik M.K.
        • Cripps P.
        • Iff I.
        A clinical comparison between a non-invasive blood pressure monitor using high definition oscillometry (Memodiagnostic MD 15/90 Pro) and invasive arterial blood pressure measurement in anaesthetized dogs.
        Vet Anaesth Analg. 2013; 40: 503-511
        • Sadler R.A.
        • Hall N.H.
        • Kass P.H.
        • et al.
        Comparison of noninvasive blood pressure measurement techniques via the coccygeal artery in anesthetized cheetahs (Acinonyx jubatus).
        J Zoo Wildl Med. 2013; 44: 928-935
        • Sant Cassia E.V.
        • Boswood A.
        • Tordiffe A.S.W.
        Comparison of high-definition oscillometric and direct arterial blood pressure measurement in anesthetized cheetahs (Acinonyx jubatus).
        J Zoo Wildl Med. 2015; 46: 506-516
        • Sawyer D.C.
        • Brown M.
        • Striler E.L.
        • et al.
        Comparison of direct and indirect blood pressure measurement in anesthetized dogs.
        Lab Anim Sci. 1991; 41: 134—138
        • Sprafka M.J.
        • Strickland D.
        • Gómez-Marín O.
        • et al.
        The effect of cuff size on blood pressure measurement in adults.
        Epidemiology. 1991; 2: 214-217
        • Stegmann G.F.
        • Jago M.
        Cardiopulmonary effects of medetomidine or midazolam in combination with ketamine or tiletamine/zolazepam for the immobilisation of captive cheetahs (Acinonyx jubatus).
        J S Afr Vet Assoc. 2006; 77: 205-209
        • Tearney C.C.
        • Guedes A.G.P.
        • Brosnan R.J.
        Equivalence between invasive and oscillometric blood pressures at different anatomic locations in healthy normotensive anaesthetised horses.
        Equine Vet J. 2016; 48: 357-361
        • Waddell L.S.
        Direct blood pressure monitoring.
        Clin Tech Small Anim Pract. 2000; 15: 111-118
        • van Zeeland Y.R.A.
        • Wilde A.
        • Bosman I.H.
        • et al.
        Non-invasive blood pressure measurement in ferrets (Mustela putorius furo) using high definition oscillometry.
        Vet J. 2017; 228: 53-62