Clinical use of a new tourniquet system for foot and ankle surgery

Ishii, Yoshinori; Noguchi, Hideo; Takeda, Mitsuhiro

doi:10.1007/s00264-009-0804-3

Cited by 13 publications

(10 citation statements)

References 17 publications

(28 reference statements)

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“…As is known to all, blood pressure is not always constant and can vary with conditions, and pneumatic tourniquets based on these methods could not respond to blood pressure changes; any necessary adjustments had to be made manually. Yoshinori Ishii reported a new pneumatic tourniquet, in which the inflation pressure is only determined by systolic blood pressure detected by an additional vital information monitor, and this made the system more complicated [ 9 , 10 ]. Tourniquet systems developed by McEwen JA et al [ 11 ] using limb occlusion pressure (LOP) to stop the arterial blood flow, which detected by an added blood flow transducer.…”

Section: Introductionmentioning

confidence: 99%

Development of adaptive pneumatic tourniquet systems based on minimal inflation pressure for upper limb surgeries

et al. 2013

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BackgroundPneumatic tourniquets are medical devices that occlude blood flow to distal part of extremities and are commonly used in upper limb surgeries to provide a dry, clean and bloodless field. To decrease pressure-related injuries and potential risk of complications subjected to the high inflation pressure of pneumatic tourniquet, minimal inflation pressures are recommended.MethodsA new occlusion pressure mathematical model for the upper limb was established based on the correlation analysis between several possible influencing parameters and the minimal pneumatic tourniquet pressure at which the peripheral pulse disappeared was recorded using a digital plethysmograph. A prototype of an adaptive pneumatic tourniquet which automatically varies the pressure in the tourniquet cuff according to the above prediction model was developed for the upper limb which used the lowest possible inflation pressure to achieve occlusion. The prototype comprises a blood pressure monitoring module, an inflatable tourniquet cuff, and a pressure relief mechanism to maintain an optimal cuff inflation pressure. Simulation experiments were conducted to verify the function and stability of the designed adaptive pneumatic tourniquet and clinical experiments using volunteers were undertaken to evaluate the performance of the prototype design in achieving adequate haemostasis in the upper limb.ResultsResults demonstrated that the mean arterial occlusion pressure was 152.3 ± 16.7 mmHg, obviously below the 250 to 300 mmHg previously recommended (J Bone Joint Surg Br 68:625-628, 1986 and Arthroscopy 11:307–311, 1995).ConclusionsIn conclusion, this adaptive method and apparatus which can provide minimal inflation pressure may be a clinically practical alternative for upper limb surgery performed with pneumatic tourniquets.

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Section: Introductionmentioning

confidence: 99%

Development of adaptive pneumatic tourniquet systems based on minimal inflation pressure for upper limb surgeries

et al. 2013

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“…This might result in additional time used to manually adjust pressure, or contaminating the dry surgical field and promoting tissue edema by oozing. Ishii et al [ 7 ] previously advocated the usefulness of a new tourniquet system for foot and ankle surgery with tourniquet inflation pressure in synchrony with systolic blood pressure (SBP) to maintain a bloodless surgical field. The current study reports the results of clinical application of this new tourniquet system for upper limb surgery.…”

Section: Introductionmentioning

confidence: 99%

Safety and efficacy of a new tourniquet system

Sato¹,

Ishii²,

Noguchi³

et al. 2012

BMC Surg

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BackgroundIn upper limb surgery, the pneumatic tourniquet is an essential tool to provide a clean, bloodless surgical field, improving visualization of anatomical structures and preventing iatrogenic failure. Optimal inflation pressure to accomplish these objects without injuring normal tissue and inducing complications is not yet established. Use of the minimum tourniquet pressure necessary to produce a bloodless surgical field is preferable in order to prevent injury to normal tissue. Various methods have been implemented in an effort to lower effective cuff pressure. The purpose of this study is to report clinical experience with a new tourniquet system in which pressure is synchronized with systolic blood pressure (SBP) using a vital information monitor.MethodsWe routinely used the tourniquet system in 120 consecutive upper limb surgeries performed under general anaesthesia in our operating room instead of our clinic. Cuff pressure was automatically regulated to additional 100 mmHg based on the SBP and was renewed every 2.5 minutes intervals.ResultsAn excellent bloodless field was obtained in 119 cases, with the exception of one case of a 44-year-old woman who underwent internal screw fixation of metacarpal fracture. No complications, such as compartment syndrome, deep vein disorder, skin disorder, paresis, or nerve damage, occurred during or after surgery.ConclusionsThis new tourniquet system, synchronized with SBP, can be varied to correspond with sharp rises or drops in SBP to supply adequate pressure. The system reduces labor needed to deflate and re-inflate to achieve different pressures. It also seemed to contribute to the safety in upper limb surgery, in spite of rare unexpected oozing mid-surgery, by reducing tissue pressure.

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“…New automatic tourniquet systems have recently been described and could be useful in this type of surgery. The pressure of these tourniquets varies automatically with the systolic blood pressure given a certain range of pressure chosen at initial setting (Ishii et al, 2009). …”

Section: Discussionmentioning

confidence: 99%