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To the Editor.—I would have no particular objection to the use of four intravenous cannulas provided starting of the extra two does not delay surgery and provided that they are sufficiently watched to avoid overloading the patient. However, we have found two intravenous catheters to be sufficient in most cases. This is related, in part, to our method of handling the aneurysm patient. Transfusion of blood is not begun in most cases until the patient is ready for anesthesia and incision, since transfusion before this time may result in recurrence of or increase in bleeding. Following incision, aortic control can be gained within one minute with the hand or an instrument. No further surgery is done at this time until adequate transfusion has been done and an adequate blood pressure attained. Subsequently, with control of the aorta, dissection can be done and a clamp applied. Most patients with ruptured
GRAHAM AL. COMMENTS ON GRAHAM ET AL'S ARTICLE IN DECEMBER 1968 ISSUE-Reply. Arch Surg. 1969;98(5):677. doi:10.1001/archsurg.1969.01340110169028