Optimizing tourniquet application and release times in extremity surgery. A biochemical and ultrastructural study.

Sapega, Alexander A.; Heppenstall, R. Bruce; Chance, B; Park, Y S; Sokolow, D

doi:10.2106/00004623-198567020-00018

Cited by 182 publications

(97 citation statements)

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“…9,14,15 Skeletal muscle may be more sensitive to an ischemic condition than peripheral nerves. 16 The use of the tourniquet is considered to be a risk for nerve injury in the affected extremity. There may be different reasons for this, but the injury is not considered to be mainly due to ischemia distal to the tourniquet cuff, but depends primarily on the combination of ischemia, pressure forces, and shear forces underneath the inflated cuff.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of pain in bilateral total knee replacement with and without tourniquet; a prospective randomized control trial

Kumar

Yadav

Singh

et al. 2015

Journal of Clinical Orthopaedics and Trauma

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Section: Discussionmentioning

confidence: 99%

Evaluation of pain in bilateral total knee replacement with and without tourniquet; a prospective randomized control trial

Kumar

Yadav

Singh

et al. 2015

Journal of Clinical Orthopaedics and Trauma

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“…The time period during which it is safe to apply a tourniquet on a limb is important in surgical practice (24,41). Similarly, the orthopaedist should know the minimum pressure necessary to occlude blood flow in a limb so as not to cause complications due to excessive compression.…”

Section: Development Of Better Tourniquet Design More Effective Comprmentioning

confidence: 99%

Tissue fluid pressures: From basic research tools to clinical applications

Hargens¹,

Akeson²,

Mubarak³

et al. 1989

Journal Orthopaedic Research

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Summary:The two basic research tools developed to measure tissue fluid pressure (wick catheter) and osmotic pressure (colloid osmometer) have undergone extensive validation and refinement over the past 20 years. Using these techniques, basic science investigations were undertaken of edema in Amazon reptiles, pressure-volume relations in animals and plants, adaptive physiology of Antarctic penguins and fishes, edema in spawning salmon, tissue fluid balance in humans under normal conditions and during simulated weightlessness, and orthostatic adaptation in a mammal with high and variable blood pressures-the giraffe. Twenty years ago, techniques were developed for basic science studies of interstitial fluid pressure and colloid osmotic pressure during the 1967 R/V ALPHA HELIX Expedition to the Amazon River (21,43). The wick catheter technique was used to examine pressure-volume relationships in animal tissues, and a simple colloid osmometer was employed to assess blood samples from Amazon animals. These techniques were refined during subsequent expeditions from Scripps Institution of

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“…The safety of this technique is still controversial, as it has been associated with numerous postoperative complications [43]. However, an arbitrary time limit of 2 h, derived from studies on skeletal muscle metabolism and ultrastructure after prolonged ischemia, is commonly accepted in orthopedic theatres [44,45] and is considered to be safe in the absence of clinical postoperative complications [46].…”

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confidence: 99%

Effects of prolonged ischemia on human skeletal muscle microcirculation as assessed by near-infrared spectroscopy

Tujjar

Gaudio

Tofani

et al. 2016

J Clin Monit Comput

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Near-infrared spectroscopy (NIRS) has been used to detect in vivo microvascular alterations by means of a vascular occlusion test. We sought to analyse by NIRS the microcirculatory profile of patients undergoing prolonged tourniquet-induced bloodless condition for extremity surgery, and compare the results with time of ischemia and comorbidities. We conducted a prospective observational study on 42 patients undergoing upper limb surgery. Regional anaesthesia was achieved and ischemia was induced by a tourniquet cuffed at 250 mmHg. The probe of a NIRS monitor (InSpectra 325, Hutchiston, USA) was placed on the brachial muscle, and muscle oxygen saturation (StO 2 ) was recorded continuously before anaesthesia, during and after surgery. The following variables were recorded: baseline StO 2 , StO 2 desaturation slope during occlusion (dSlope, units/s), resaturation rate following ischemia (RR, units/s), hyperaemic peak (peak, units), and duration of the hyperaemic period following ischemia (hyperaemic time, s). Values of dSlope were similar among all patients. RR and hyperaemic time were significantly correlated with the duration of ischemia, but not with comorbidities [p = 0.007 CI (-35.64 to -13.1), and p \ 0.001 CI (0.049-0.159), respectively]. Grouping patients by duration of ischemia (30, 60, or 90 min), we found a significant decrease in RR after 60 and 90 min (p \ 0.001 and p = 0.03, respectively). Hyperaemic peak was lower in the 90 min group (83.9 ± 6.8 vs.91.2 ± 5.7 %, p = 0.02) whereas the hyperaemic time was significantly increased (595 ± 136 vs. 429 ± 107 min, p \ 0.001). Alterations of skeletal muscle microcirculation were correlated with the duration of ischemia, but not with comorbidities. We observed an initial impairment of the microcirculatory recovery at 90 min of ischemia.

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Optimizing tourniquet application and release times in extremity surgery. A biochemical and ultrastructural study.

Cited by 182 publications

References 0 publications

Evaluation of pain in bilateral total knee replacement with and without tourniquet; a prospective randomized control trial

Evaluation of pain in bilateral total knee replacement with and without tourniquet; a prospective randomized control trial

Tissue fluid pressures: From basic research tools to clinical applications

Effects of prolonged ischemia on human skeletal muscle microcirculation as assessed by near-infrared spectroscopy

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