Massive Pulmonary Embolism and Tourniquet Deflation

Cohen, Jonathan; Keslin, J.; Nili, M; Yosipovitch, Z; Gassner, S

doi:10.1213/00000539-199409000-00032

Cited by 19 publications

(8 citation statements)

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“…Although a thromboembolus was detected in the right atrium, but not in the pulmonary trunk and the main pulmonary arteries 35 min after cardiac arrest, the only explanation is a massive PE. The time lapse between tourniquet release and the clinical manifestation was similar to that repeatedly reported in adult patients (4–6). Thus, local rheologic changes produced by the pneumatic tourniquet obviously resulted in venous thrombosis of the right leg.…”

Section: Discussionsupporting

confidence: 85%

Tourniquet use in childhood: a harmless procedure?

Sinicina

Bise

Hetterich

et al. 2007

Pediatric Anesthesia

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Tourniquet ischemia is widely used in limb surgery in every age group. In adults, tourniquet-related deep vein thrombosis and pulmonary embolism are recognized complications of tourniquet use. In healthy children, tourniquet-associated alterations of blood clotting physiology are assumed to have no clinical impact. Antithrombotic prophylaxis is, therefore, recommended only in the presence of pertinent risk factors such as extensive surgery, congenital thrombophilia, prolonged immobilization, and indwelling central venous line, however, it is not practiced in obese, otherwise healthy children. We describe the first case of fatal pulmonary thromboembolism in an obese 12-year and 3-month old boy (body mass index 27.6 kg x m(-2)) following tourniquet-deflation after minor surgery on the lower extremity.

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Section: Discussionsupporting

confidence: 85%

Tourniquet use in childhood: a harmless procedure?

Sinicina

Bise

Hetterich

et al. 2007

Pediatric Anesthesia

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“…The fibrinolytic activity is associated with a low incidence of deep venous thrombosis in the re-lated limb (26, 27). There are reports of embolic complications after tourniquet release (28,29). The probable source of embolic material is the fresh thrombi formed during tourniquet inflation (30).…”

Section: Discussionmentioning

confidence: 99%

The Addition of Low-dose Mivacurium to Lidocaine for Intravenous Regional Anesthesia

Mızrak

Bozgeyik

Karakurum

et al. 2010

Journal of Musculoskeletal Pain

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Objectives: The current study aimed to evaluate low dosage of mivacurium added to lidocaine for intravenous regional anesthesia [IVRA].Methods: The present study used a double-blind methodology. The study group comprised 60 patients with the American Society of Anesthesiologists physical status I and II, who were scheduled to undergo carpal tunnel release as an outpatient procedure. Patients were randomly divided into two groups. In the mivacurium group [Group M; N = 30], intravenous regional anesthesia was achieved using 6 mg of mivacurium with lidocaine 3 mg/kg diluted with saline to a total volume of 40 ml; in the control group [Group C; N = 30] 3 mg/kg lidocaine was diluted with saline to a total volume of 40 ml. The onset and recovery time of sensory and motor blocks, intraoperative-postoperative visual analog scale, and verbal rating scale, tourniquet pain, satisfaction score, analgesic requirement, hemodynamic variables, and side effects were noted.Results: Group M showed significantly shorter sensory block and motor block onset time, longer motor block recovery time, and decreased analgesic requirement during the 24-hour postoperative period.Conclusions: Despite the longer motor block recovery, the addition of a low dose of mivacurium to lidocaine for IVRA accelerated the sensory and motor blocks onset and improved the postoperative analgesia without important perioperative adverse effects. We demonstrated that the addition of a low dose of mivacurium to lidocaine for IVRA provided a significant clinical benefit by shortening the sensory and motor blocks onset, providing sufficient muscle relaxation, and also reducing postoperative analgesic consumption without any serious adverse effects.

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“…[13141516] These cases were also reported in either sex and in varying age groups, mostly in patients undergoing trauma surgeries. Immobilization prior to the surgery without receiving adequate anticoagulation is a common risk factor even in these cases.…”

Section: Discussionmentioning

confidence: 99%

“…Three of the patients who survived, had early diagnosis by TEE and underwent surgical embolectomy using cardiopulmonary bypass. [51014] One of the patients needed 10 days of extracorporeal membrane oxygenation (ECMO) before the recovery. [10] In two of the patients who survived, early diagnosis was made and anticoagulation with heparin was given.…”

Section: Discussionmentioning

confidence: 99%

Fatal pulmonary embolism subsequent to the use of Esmarch bandage and tourniquet: A case report and review of literature

et al. 2013

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We report a case of fatal pulmonary embolism (PE) following exsanguinations of lower limb in orthopedic surgery. A 30-year-old man was posted for fixation of a tibial plateau fracture on the seventh day after injury. Subarchnoid block was performed. Esmarch bandage was used for exsanguination of the limb and tourniquet was inflated. Within three minutes after tourniquet inflation, the patient became unconscious hypotensive, and collapsed. Resuscitation was instituted and spontaneous circulation restored. Right ventricular strain pattern on transthoracic echocardiography, increased levels of D-dimer, and Doppler examination of the lowerlimb confirmed deep venous thrombosis of right femoral vessels and PE. In spite of thrombolytic therapy with streptokinase and heparin, the patient died on the ninth day after the event. Cases of PE secondary to the use of Esmarch bandage and tourniquet are reviewed here to identify the risk groups and management of PE.

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Massive Pulmonary Embolism and Tourniquet Deflation

Cited by 19 publications

References 0 publications

Tourniquet use in childhood: a harmless procedure?

Tourniquet use in childhood: a harmless procedure?

The Addition of Low-dose Mivacurium to Lidocaine for Intravenous Regional Anesthesia

Fatal pulmonary embolism subsequent to the use of Esmarch bandage and tourniquet: A case report and review of literature

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