Safety and efficacy of a new tourniquet system

Abstract

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.

Evaluation of a new tourniquet for hand surgery: Comparison of 76 carpal tunnel syndrome cases operated using a Hemaclear® Model-F tourniquet versus a pneumatic tourniquet

“…Some would attribute the safety of the Hemaclear 1 tourniquet to its application area (same pressure per cm 2 ), which is narrower than that of a conventional pneumatic tourniquet. Others try to avoid excessive pressure when using pneumatic tourniquets by allowing automatic adaptation of the systolic pressure in real time [16]. Nevertheless we did not observe any complications in our study.…”

Tourniquet application during anesthesia: “What we need to know?”

“…Surgical texts recommend cuff pressures of 200–300 mmHg for adults. Various methods have been implemented in an effort to lower effective cuff pressure:[78910111213]…”

“…Double tourniquet technique, to change the point of compression[7]Controlled hypotension to bring down systolic blood pressure can also be used to decrease direct cuff pressure against the tissue[8]Doppler technique and pulse oximetry to confirm the absence of the arterial pulse to determine the minimum inflation pressure[9]Tourniquet inflation based on limb occlusion pressure (LOP)[1011]Cuff pressure synchronization with systolic blood pressure. [111213]…”

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“…The functional outcome was evaluated based on the quality of bloodless field and post operative complications. All surgeries were done under General Anaesthesia [7] , as the use of brachial block or Bier block for upper limb surgery and spinal anaesthesia for lower limb surgery would hamper the assessment of post-operative tourniquet palsy. Limb occlusion pressure usually was determined by gradually increasing tourniquet pressure until the distal blood flow was interrupted 8 .…”