Mehmet ŞEKER, Emir CANTÜRK, Caner ARSLAN, Levent KAPLAN, Adeviye GÖKOĞLU, Bekir KAYHAN

Radial arter kanülünün etkilerini değerlendirmede allen testinin yeri

Amaç: Kalp cerrahisinde tansiyon takibi için arter kanülü takılması ameliyat hazırlığının rutin bir parçasıdır. Bu amaçla yerleştirilen kanüllerin radial arter patensisi ve el dolaşımı üzerine etkilerini değerlendirmede Allen testinin yeterliliği araştırıldı. Çalışma planı: Kalp cerrahisi yapılan 50 hastada (39 erkek, 11 kadın; ort. yaş 56; dağılım 27-75) el dolaşımı, ameliyat öncesi dönemde ve radial arter kanülü alındıktan 10 gün sonra, Allen testi ve Doppler ultrasonografi ile değerlendirildi. Snuff-box bölgesinden radial arter debisi ölçüldü. Bulgul ar: Elli hastanın dokuzunda (%18) ultrasonografi ile ortalama %23 debi azalması tespit edilmesine rağmen Allen testleri değişmedi. Radial ve ulnar arter akımları yeterli olduğundan el iskemisi görülmedi. Sonuç: Radial arter kanülü takılan hastalarda işlem öncesi ulnar arter akımının yeterli olduğunu gösteren Allen testi el dolaşımının güvenliği için yeterli olmaktadır.

Allen test in evaluation of the effects of radial artery catheters

Background: Insertion of an arterial catheter for pressure monitoring is a routine part of anesthetic management for cardiac surgery. We investigated the efficacy of the Allen test in evaluation of the effects of catheter insertion into the radial artery on arterial patency and the hand circulation. Methods: Hand circulations in 50 patients (39 males, 11 females; mean age 56; range 27 to 75 years) who had undergone cardiac surgery, were evaluated with Allen test and doppler ultrasound preoperatively and 10 days after decannulation. Volume of flow of radial artery at snuff-box was measured. Results: Although a mean 23% decrease in the flow rate was observed in nine of 50 patients (18%), Allen’s tests did not changed. No hand ischemia was seen, because radial and ulnar artery flow was sufficient. Conclusion: Allen’s test showing efficient ulnar artery flow is enough for safety of hand circulation in patients whose radial arteries were cannulated.

PDF

___

1. Mandel MA, Dauchot PJ. Radial artery cannulation in 1,000 patients: precautions and complications. J Hand Surg [Am] 1977;2:482-5.
2. Slogoff S, Keats AS, Arlund C. On the safety of radial artery cannulation. Anesthesiology 1983;59:42-7.
3. Ruengsakulrach P, Brooks M, Hare DL, Gordon I, Buxton BF. Preoperative assessment of hand circulation by means of Doppler ultrasonography and the modified Allen test. J Thorac Cardiovasc Surg 2001;121:526-31.
4. Desai ND, Cohen EA, Naylor CD, Fremes SE; Radial Artery Patency Study Investigators. A randomized comparison of radial-artery and saphenous-vein coronary bypass grafts. N Engl J Med 2004;351:2302-9.
5. Greenwood MJ, Della-Siega AJ, Fretz EB, Kinloch D, Klinke P, Mildenberger R, et al. Vascular communications of the hand in patients being considered for transradial coronary angiography: is the Allen’s test accurate? J Am Coll Cardiol 2005;46:2013-7.
6. Agrifoglio M, Dainese L, Pasotti S, Galanti A, Cannata A, Roberto M, et al. Preoperative assessment of the radial artery for coronary artery bypass grafting: is the clinical Allen test adequate? Ann Thorac Surg 2005;79:570-2.
7. Manabe S, Tabuchi N, Tanaka H, Arai H, Sunamori M. Hand circulation after radial artery harvest for coronary artery bypass grafting. J Med Dent Sci 2005;52:101-7.
8. Baker RJ, Chunprapaph B, Nyhus LM. Severe ischemia of the hand following radial artery catheterization. Surgery 1976;80:449-57.
9. Wilkins RG. Radial artery cannulation and ischaemic damage: a review. Anaesthesia 1985;40:896-9.
10. Lee KL, Miller JG, Laitung G. Hand ischaemia following radial artery cannulation. J Hand Surg [Br] 1995;20:493-5.
11. Valentine RJ, Modrall JG, Clagett GP. Hand ischemia after radial artery cannulation. J Am Coll Surg 2005;201:18-22.
12. Sfeir R, Khoury S, Khoury G, Rustum J, Ghabash M. Ischaemia of the hand after radial artery monitoring. Cardiovasc Surg 1996;4:456-8.