SUMMARY
1. Blood loss estimations have been made on ninety‐two patients undergoing retropubic prostatectomy.
2. The reduction of blood loss achieved by the use of controlled hypotension has been studied.
3. The influence of a number of variable factors is shown.
4. No increase in mortality rate following the use of controlled hypotension has been demonstrated.
The direct continuous measurement of the arterial pressure is a monitoring technique little used outside the field of open-heart surgery. The questionable safety and technical difficulty of arterial cannulation together with the expense and complexity of measuring equipment are the reasons usually advanced for the limited use of this technique.This study was undertaken to show that radial artery cannulation is a safe technique and that, using simple and inexpensive equipment, direct, continuous arterial pressure measurements can be adopted for routine use in major surgery, in the care of the critically ill patient and for research purposes.
METHOD
Arterial cannulationIn this study, only the radial artery at the wrist has been used for cannulation. This is because of the lack of reported complications from radial artery puncture, its accessibility and the ease of applying an effective pressure dressing.After the induction of anaesthesia, the radial arteries are palpated and then firmly compressed to confirm the adequacy of the collateral circulation'. The appropriate arm is selected either for convenience of position or for ease of palpation of the artery and, following cleansing of the skin, a small nick is made with a No. 11 scalpel blade just over the proposed site of puncture. A disposable Guest cannula mounted on a 2ml syringe is then introduced through the nick and into the lumen of the artery. Not uncommonly the needle passes right through the vessel in which case it is withdrawn until a free flow of blood is obtained and it is then advanced up the lumen.Once the cannula is in position, the needle is withdrawn and a sterile, disposable, plastic tap is attached. The tap and cannula are then flushed with a previously prepared heparin/saline solution to prevent clotting. The cannula is firmly strapped to the wrist, the 'wings' facilitating firm fixing (figure 1).
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