Pneumatic Tourniquet and Limb Blood Flow

Santavirta, Seppo; Höckerstedt, Krister; Linden, Hans van der

doi:10.3109/17453677808993239

Cited by 18 publications

(13 citation statements)

References 15 publications

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“…Reactive hyperemia and an increased fibrinolytic activity occur a few minutes after tourniquet release, leading to excessive bleeding [37][38][39][40][41]. Wound closure and apposing tissue layers with a firmly applied dressing can produce a local compressive effect and control this bleeding.…”

Section: Discussionmentioning

confidence: 98%

Comparative efficacy of different doses of fibrin sealant to reduce bleeding after total knee arthroplasty

Notarnicola¹,

Moretti²,

Martucci³

et al. 2012

Blood Coagulation &Amp; Fibrinolysis

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In recent years, the application of fibrin sealant has been shown to be efficacious in the management of intraoperative and postoperative hemostasis. We designed a prospective randomized controlled clinical trial to assess the efficacy of two different dosages of fibrin sealant (5 and 10 ml) in patients undergoing total knee arthroplasty, as compared with the untreated control group. A total of 90 patients entered the study, randomly assigned to one of the three groups: treatment with 5 ml fibrin sealant (30 patients), with 10 ml fibrin sealant (30 patients) or no treatment (30 patients). A statistically significant difference in the mean reduction of hemoglobin concentrations was found on the first postoperative day in the treated groups as compared with the controls: 5 ml fibrin sealant (2.6 mg/dl) and 10 ml fibrin sealant (2.5 mg/dl) vs. controls (3.7 mg/dl) (P = 0.024). The mean number of blood transfusions was significantly lower in the treated groups: 5 ml (0.5) and 10 ml (0.3) of fibrin sealant vs. controls (1) (P = 0.0019). Functional recovery was also better in the treated groups: on the seventh day, the joint ROM (range of motion) was statistically superior in the 5 ml group (96.5°) and 10 ml group (98.8°) as compared with the controls (75.5°) (P < 0.0001). This study supports the efficacy of administering fibrin sealant in the perioperative management of bleeding after total knee arthroplasty and shows that a 5 ml dosage yields a comparable outcome to the 10 ml dosage previously reported in the literature.

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Section: Discussionmentioning

confidence: 98%

Comparative efficacy of different doses of fibrin sealant to reduce bleeding after total knee arthroplasty

Notarnicola¹,

Moretti²,

Martucci³

et al. 2012

Blood Coagulation &Amp; Fibrinolysis

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“…Metabolic changes are well-described for tissues subjected to tourniquet ischemia (Dery et al 1965, Wilgis 1971, Haljamae and Enger 1975, Enger 1977, Jennische et al 1978, Larsson and Bergstrom 1978, Modig et al 1978, Santavirta et al 1978, Heppenstall et al 1979, Miller et al 1979, Rorabeck 1980, Jennische et al 1982, Nakahara 1984, Newman 1984, Cotellessa et al 1984, Hagberg et al 1985, Sapega et al 1985, Heppenstall et al 1986, Pate1 et al 1987, Benzon et al 1988, Soussi 1989. Levels of oxygen, phosphocreatine, glycogen, and ATP decrease, while the concentrations of lactate, carbon dioxide, and other metabolic by-products increase as metabolism shifts to predominantly anaerobic pathways.…”

Section: Mechanisms Of Tourniquet-induced Muscle Injurymentioning

confidence: 99%

“…however such blood flow is inadequate to maintain aerobic metabolism (Klenerman and Crawley 1977). Reactive hyperemia and arterial vasodilatation follow brief periods of tissue ischemia (Romanus 1977, Larsson and Lewis 1978, Santavirta et al 1978, Kennedy et al 1981, Klenerman et al 1982, Barie and Mullins 1988, Authier 1988. Tissue edema follows reperfusion after thirty minutes to four hours of skeletal muscle ischemia (Paletta et al 1960, Miller et al 1979, Klenerman et al 1982, Korthius et al 1985, Silver et al 1986, Suva1 et al 1987, Dreyfuss and Smith 1988, Gidlof 1988, Soussi 1989.…”

Section: Mechanisms Of Tourniquet-induced Muscle Injurymentioning

confidence: 99%

Tourniquet-induced neuromuscular injury

Pedowitz

1991

Acta Orthopaedica Scandinavica

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“…Previous studies (Blond and Madsen, 2003a; Furlow, 1971; Klenerman and Crawley, 1977; Santavirta et al, 1978; Spira et al, 1965) have identified that some blood passes under the tourniquet into the arm through bone marrow vessels. However, there are very little clinical data available and the clinical consequence of this has not been evaluated.…”

mentioning

confidence: 97%

Clinical Consequences of Different Exsanguination Methods in Hand Surgery. A Double-blind Randomised Study

Blønd

Jensen

Nielsen

2008

J Hand Surg Eur Vol

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A randomised trial was performed in 100 patients in order to evaluate the effectiveness of three commonly used methods of exsanguination (simple elevation, squeeze method and Esmarch bandage) in a clinical setting. The quality and quantity of the exsanguination was evaluated every 5 min by the surgeon and the amount of oozing was observed. Although there was no significant difference between squeezing the arm and Esmarch bandaging, both resulted in significantly better exsanguination than simple elevation. In 22 out of the 100 patients, a small amount of ooze was observed. The oozing was observed significantly more frequently in the patients exsanguinated by simple elevation.

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Pneumatic Tourniquet and Limb Blood Flow

Cited by 18 publications

References 15 publications

Comparative efficacy of different doses of fibrin sealant to reduce bleeding after total knee arthroplasty

Comparative efficacy of different doses of fibrin sealant to reduce bleeding after total knee arthroplasty

Tourniquet-induced neuromuscular injury

Clinical Consequences of Different Exsanguination Methods in Hand Surgery. A Double-blind Randomised Study

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