Is invasive anesthetic monitoring necessary during radical prostatectomy?

The purpose of this study was to obtain objective information on the necess ity of invasive anesthetic monitoring during radical prostatectomy. We revi ewed retrospectively the charts of 257 patients undergoing radical prostate ctomy on an established pathway which did not include the intraoperative us e of an arterial line or central venous catheter. Outcome measures includin g intraoperative vital signs, cardiac arrhythmias, blood loss and fluid man agement were assessed. In particular, we sought to determine situations in which insertion of monitoring devices was required because of an unanticipa ted intraoperative event. The patient ages ranged from 40 to 75y with a mea n of 60.3 y. The mean estimated blood loss was 546.9 cm(3) (median 500 cm(3 )). Thirty-eight patients had a measured intraoperative systolic blood pres sure of < 90 mmHg, but no hypotensive episodes required any treatment other than fluid administration. A single patient required pharmacologic therapy for hypertension. One patient received intravenous lidocaine because of pr emature ventricular contractions, but no other arrhythmias were observed. N o patient required intraoperative insertion of an arterial line or central venous catheter. These data provide objective evidence for the abandonment of routine use of central venous catheters or arterial lines during radical prostatectomy. This avoids not only the expense of these maneuvers, but al so the potential morbidity of unnecessary invasive medical procedures.