COMPARISON BETWEEN THE ULTRASOUND GUIDED DYNAMIC NEEDLE TIP POSITIONING USING SHORT-AXIS, OUT-OF-PLANE APPROACH AND LONGITUDINAL OBLIQUE AXIS APPROACH FOR RADIAL ARTERY CANNULATION IN PATIENTS UNDERGOING EMERGENCY EXPLORATORY LAPROTOMY WITH PERIOPERATIVE HYPOTENSION - A PROSPECTIVE RANDOMIZED NON-INFERIORITY TRIAL

The two main techniques for Ultrasound guided radial artery RA cannulation are Longaxis,in plane LA IP and short-axis out plane SA OP technique Longitudinal oblique axis LOA is a modified LA IP technique which provides wider visualized area as well direct needle visualization. LOA and Dynamic needle tip positioning DNTP have come up as an alternative techniques for LA IP and SA OP respectively  SA OP with DNTP has been established as the desirable technique however LOA has emerged as the promising technique in terms of higher success rate We hypothesize LOA to be non inferior to SA OP with DNTP  On literature search these techniques have not been evaluated in patients with difficult cannulation eg obesity and hypotension All routine standard monitors will be attached The hypotension will be managed by vasopressors and inotropes as per the protocol  In all patients Modified Allens test will be performed with the arm placed on a flat armrest in moderate dorsiflexion 30 degree to 45 degree which will be achieved by placing a towel under the dorsal aspect of wrist  Patients will be randomized into group D and O In group D DNTP using SA OP will be used and in group O LOA approach will be used  Various parameters like Time for successful cannulation Imaging time first attempt success rate number of attempts  failure rate  overall success rate complications and operator satisfaction rate will be recorded