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Physical Examination of the Hand
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
Arterial territories: An Allen test assists in deciding whether the radial or ulnar artery is responsible for the major artery supply to the hand. An Allen test (Figures 3.19 and 3.20) (Videos 3.10 and 3.11) manoeuvre is performed at the wrist level and repeated to look for the predominant blood supply. Usually, radial artery remains the predominant artery supply for the hand.
Management of vascular complications during nonvascular operations
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Kush Sharma, M. Ashraf Mansour
The radial artery is a convenient location for cannula placement when close hemodynamic monitoring is required.40 Given that the ulnar artery provides dominant flow to the hand in most patients, radial artery cannulation complications such as thrombosis are either unrecognized or well tolerated resulting in nonoperative management.40 Furthermore, the radial artery is frequently the preferred access vessel for diagnostic coronary angiography. Studies have demonstrated decreased flow or thrombosis after radial artery decannulation in 25–33% of patients, but hand ischemia is seen in < 1% of cases.41 Given the frequency of arterial line placement, it is important for a vascular surgeon to be aware of these complications. Of course, the “Allen test” should be performed prior to using the radial artery as an access vessel for angiography or monitoring.
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Published in Anton Sebastian, A Dictionary of the History of Medicine, 2018
Allen Test A test for peripheral vascular disease of the hand, by compressing and relieving the ulnar and radial vessels and observing color changes. Described by E.V. Allen (1900–1961), a medical graduate from Nebraska. He became professor of medicine at the Mayo Clinic and wrote a treatise on peripheral arterial disease.
Optimal Dose of Dexmedetomidine for Perioperative Blood Glucose Regulation in Non-Diabetic Patients Undergoing Gastrointestinal Malignant Tumor Resection: A Randomized Double-Blinded Controlled Trial
Published in Journal of Investigative Surgery, 2021
Wei Zhou, Dongsheng Zhang, Shunping Tian, Chao Tan, Rongrong Ma, Jing Zhang, Jianhong Sun, Zhuan Zhang
None of the patients received preoperative medication. Routine monitoring including SpO2, ECG and noninvasive BP were performed once patients entered the operating room. Ultrasound-guided right internal jugular vein puncture was performed under local anesthesia, and a double-lumen catheter was inserted to a depth of 13–14 cm. After successful catheterization, Ringer's solution was infused at a rate of 1.5 ml/kg/h. Patients with a positive result on the modified Allen test were catheterized with radial artery puncture under local anesthesia to monitor invasive arterial pressure (IAP). Narcotrend (MT Monitortechnik GmbH&Co.KG, Germany) was used to monitor the depth of anesthesia. Groups D1, D2, and D3 were given an intravenous injection of dexmedetomidine (200 mcg/mL, 17223BP, 180528BP, 190118BP, Jiangsu Hengrui Pharmaceutical Co., Ltd.) at 1 mcg/kg for 10 min before general anesthesia induction, that was maintained with rates of 0.25, 0.5, and 1 mcg/kg/h, respectively, until approximately 30 min before the end of surgery. Group C was given intravenous saline at a rate of 50 mL/h for 10 min, followed by continuous infusion at a rate of 10 mL/h until about 30 min before the end of surgery. The dexmedetomidine and saline solutions used in each group were intravenously pumped through the fourth channel of a syringe pump (CP-2100, Beijing Silugao Medical Technology Co., Ltd., China), which was covered with a piece of opaque sheet.
Clinical management of squamous cell carcinoma of the tongue: patients not eligible for free flaps, a systematic review of the literature
Published in Expert Review of Anticancer Therapy, 2021
Giuseppe Colella, Raffaele Rauso, Davide De Cicco, Ciro Emiliano Boschetti, Brigida Iorio, Chiara Spuntarelli, Renato Franco, Gianpaolo Tartaro
Among all microsurgical choices for the reconstruction of the tongue, the radial forearm free flap (RFFF), the anterolateral thigh free flap (ALT), and the lateral arm free flap (LAFF) are the mostly used. Various advantages made the RFFF the most popular reconstructive option: a long and relatively constant pedicle; the diameter of the vessels is similar to those located in the neck, allowing easy anastomoses; the flap provide a thin tissue that can be easily shaped, folded or twisted [37–39]. Furthermore, the RFFF showed little bloating in postoperative period minimizing the impact of surgery in affecting respiration and language [40]. A failed Allen test represent an absolute contraindication to this flap, while previous wrist fractures or lacerations of the donor site are considered relative contraindications [38,39]. Main disadvantages of the RFFF include the possibility of injuries to the radial and median nerves (that can causes motor disability and hypo-/anesthesia of the snuffbox, the hand and fingers), the extended and unpleasant donor site scars and the prolonged healing in case of inability to primary closure [37–41].
Blood pressure measurement in obese patients: non-invasive proximal forearm versus direct intra-arterial measurements
Published in Southern African Journal of Anaesthesia and Analgesia, 2018
A Verkhovsky, M Smit, A Levin, JF Coetzee
Approval for the study was obtained from the Stellenbosch University Human Research Ethics Committee (project number S15/05/099). Informed consent was obtained before enrolment. Inclusion criteria comprised obese patients with body mass index ≥30 kg.m−2 and in whom intraoperative direct intra-arterial blood pressure measurement was considered mandatory by the attending anaesthesiologists. Exclusion criteria included patients with a MAP difference of more than 20 mmHg between their upper arms as measured by automated oscillometric NIBP, a history of or concurrent known arterial vascular occlusive diseases such as thromboangiitis obliterans, Takayasu’s disease, Raynaud’s disease, lupus, scleroderma, rheumatoid arthritis, thoracic outlet syndrome, and a history of upper extremity embolisation.20,21 Contraindications for intra-arterial catheterisation including a negative Allen test, a history of Raynaud’s phenomenon or brachial artery injury, which were also not considered for enrolment.21 Patients with contra-indications to non-invasive blood pressure cuff placement such as the presence of an upper limb arteriovenous fistula for renal dialysis, previous lymph node removal and lymphoedema were also not considered for enrolment. Patients with dysrhythmias and pre-existing hypotension were also excluded as NIBP is potentially inaccurate in these circumstances.22