Clinical Utilization of Arterial Occlusion Pressure Estimation Method in Lower Limb Surgery: Tourniquet Pressures and Their Effectiveness

Abstract

Clinical utilization of the AOP estimation formula is a practical and effective way of setting tourniquet pressures for lower limb surgery. Its usage allows achievement of a bloodless field with inflation pressures lower than those previously recommended in the literature for lower limb tourniquets.

Obese patients require higher, but not high pneumatic tourniquet inflation pressures using a novel technique during total knee arthroplasty

“…In our previous studies, we used a CHAMIP technique which provided a bloodless field in all patients with a mean tourniquet pressure of 169.7±7.9 mmHg and 118.2±7.2 mmHg which were significantly lower inflation pressures than reported and recommended in the literature in lower and upper extremity surgeries respectively. [13,14,19] Nwachukwu et al [20] also found that obesity is an independent risk factor for poor hemodynamic control during TKA. In our study, the mean initial systolic blood pressures and the mean intraoperative maximal systolic blood pressures were found to be more elevated in obese group.…”

“…Therefore, we used the controlled hypotension and minimal inflation pressure (CHAMIP) technique, which provided a bloodless field in all patients, with a mean tourniquet pressure of 169.7±7.9 mmHg for lower extremity surgeries and 118.2±7.2 mmHg for upper extremity surgeries in our previous studies, values significantly lower than those previously reported and recommended in the literature. [13,14] In all patients, the thigh circumference was measured 20 cm proximal to the superior pole of the patella with the knee extended by a tape measure and recorded. The tourniquet cuff was placed around the thigh with the distal edge 15 cm proximal to proximal…”

Does Tourniquet Time or Pressure Contribute to Intracranial Pressure Increase following Tourniquet Application?

“…It has also been determined that these pressures are sufficient to provide a bloodless surgical site [6]. Olivecrona et al [20] compared tourniquet applications by SBP and AOP and found that an adequate bloodless surgical site could be provided with lower pressure and that the postoperative complication rate was lower in patients who underwent the AOP technique.…”

“…The initial SBP was measured, and the corresponding tissue padding coefficient value (K TP ) was used [6]. A final TP was achieved by adding 20 mm Hg to the AOP value for safety purposes.…”

“…In recent years, minimal tourniquet inflation pressure has been used instead of traditional tourniquet pressure (TP) values to reduce complications caused by excessive TP. Bloodless surgical fields can be achieved at a much lower pressure than conventional TP by using a method formulated with arterial occlusion pressure (AOP), systolic blood pressure (SBP), and tissue padding coefficient (K TP ) values according to the circumference of the extremity (AOP = [SBP + 10]/K TP ) [6, 7]. …”