The Use of Lower Tourniquet Inflation Pressures in Extremity Surgery Facilitated by Curved and Wide Tourniquets and an Integrated Cuff Inflation System

Pedowitz, Robert A.; Gershuni, David H.; Botte, Michael J.; Kuiper, Scott D.; Rydevik, Bj Rn; Hargens, Alan R.

doi:10.1097/00003086-199302000-00038

Cited by 64 publications

(67 citation statements)

References 11 publications

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“…4. Muscle Injury As with tourniquet related nerve damage, muscle tissue injury beneath and distal to tourniquet sites have been shown in clinical and animal studies to be directly correlated to application times and pressures [32,61]. Inflammatory changes, focal and regional necrosis and hyaline degeneration take place following microvascular compression and superoxide free radical endothelial damage.…”

Section: Painmentioning

confidence: 99%

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Tourniquet Use in Upper Limb Surgery

Oragui

Parsons

White

et al. 2010

Hand (New York, N,Y.)

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Tourniquets are compressive devices that occlude venous and arterial blood flow to limbs and are commonly used in upper limb surgery. With the potential risk of complications, there is some debate as to whether tourniquets should continue to be routinely used. In this review, we first look at the different designs, principles, and practical considerations associated with the use of tourniquets in the upper limb. The modern pneumatic tourniquet has many design features that enhance its safety profile. Current literature suggests that the risk of tourniquet-related complications can be significantly reduced by selecting cuff inflation pressures based on the limb occlusion pressure, and by a better understanding of the actual level of pressure within the soft tissue, and the effects of cuff width and contour. The evidence behind tourniquet time, placement, and limb exsanguination is also discussed as well as special considerations in patients with diabetes mellitus, hypertension, vascular calcification, sickle cell disease and obesity. We also provide an evidence-based review of the variety of local and systemic complications that may arise from the use of upper limb tourniquets including pain, leakage, and nerve, muscle, and skin injuries. The evidence in the literature suggests that upper limb tourniquets are beneficial in promoting optimum surgical conditions and modern tourniquet use is associated with a low rate of adverse events. With the improvement in knowledge and technology, the incidence of adverse events should continue to decrease. We recommend the use of tourniquets in upper limb surgery where no contraindications exist.

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Section: Painmentioning

confidence: 99%

“…Recovery time is proportional to ischemic duration. After 3 h of cuff inflation the recovery time may be significantly increased [32,49,61,69,70]. Rhabdomyolysis due to prolonged tourniquet application is well-documented [58,72,81].…”

Section: Painmentioning

confidence: 99%

Tourniquet Use in Upper Limb Surgery

Oragui

Parsons

White

et al. 2010

Hand (New York, N,Y.)

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“…Limb occlusion pressure usually was determined by gradually increasing tourniquet pressure until the distal blood flow was interrupted 8 . Previous studies [9,10] showed that cuff inflation pressure based on LOP measured for each patient before inflation of cuff were generally lower than predetermined generic inflation pressure but were sufficient to maintain a satisfactory operative field. After limb occlusion pressure is measured, tourniquet pressure is typically set by adding to the LOP an additional safety margin that is selected to be greater than the magnitude of any increase in LOP normally expected during the operation.…”

Section: Discussionmentioning

confidence: 95%

A clinical study of the safe use of pneumatic tourniquet in orthopaedic surgery

Adhikari¹,

Nekkanti²,

Hg³

et al. 2017

Int. J. Orthop. Sci.

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Specific objective: A study was undertaken to evaluate the superiority of Lowest occlusion pressure method of using the pneumatic tourniquet verus the other routine ways of usage of Pneumatic Tourniquets in Orthopaedics surgery which include the Fixed and Systolic Blood Pressure variants. Materials and methods:This study included 120 patients of both upper and lower limbs trauma. These patients were randomly included any of the three categories of study after fullfilling the inclusion and exclusion criteria. Three modalities of application of toruniquet were included in this study. They were Fixed, Systolic Blood pressure (SBP) and Lowest Occlusion Pressure methods (LOP). Each category included 40 patients and the results were analysed according to final outcome using Ishii et al. grading, VAS Score criteria. Results: In our study 120 cases managed by LOP had better results compared to fixed variant and Systolic BP variant in terms of less pressure needed to keep tourniquet, good operative field, pain score (VAS) at tourniquet application region and skin injury (reddening). But no complications like compartment syndrome, deep vein disorder, paresis, nerve injury has occurred before and after surgery Conclusion: LOP method of using the pneuamtic tourniquet is superior to the other methods of using Tourniquet in terms of less pressure needed for elevating tourniquet, Good operative (blood less) field, no skin abrasions.Keywords: Pneumatic tourniquet, lowest occlusion pressure, systolic blood pressure, orthopaedic surgery IntroductionThe use of pneumatic tourniquet in orthopaedic surgery has been widely debated over the years. A pneumatic tourniquet is a device that allows the surgeon to have a bloodless field for the duration of the surgery [1,2] . This allows the surgeon to reduce the surgical time since all the anatomic structures are clearly visualised. The reason for debate is due to the postoperative problems experienced by the patient. Tourniquet site pain, tourniquet palsy, chemical burns at the site of tourniquet are common patient related problems consequent to using a tourniquet [3][4][5] . Great efforts have been made to identify the minimum pressure to which the tourniquet should be inflated so as to avoid the above mentioned problems. [6] In this study, we aim to use the pneumatic tourniquet by inflating it to the lowest occlusion pressure (LOP) and study its effects in terms of quality of bloodless field and post-operative complications. The results were compared with the standard techniques of using a tourniquet described already in the literature.

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“…For a given patient, the cuff pressure needed to occlude arterial flow is affected by various factors, including systolic blood pressure (Van Roeckel and Thurston 1985), limb circumference (Van Roeckel and Thurston 1985, Moore et al 1987, Crenshaw et al 1988, Pedowitz et al 1992c, limb shape and local anatomy (Rorabeck and Kennedy 1980), vascular status Lewis 1976, Jeyaseelan et al 1981), and the width of the applied tourniquet (Muirhead and Newman 1986, Moore et al 1987, Crenshaw et al 1988. Cuff design may also influence the tourniquet pressure needed to induce surgical hemostasis (Pedowitz et al 1992~).…”

Section: Discussionmentioning

confidence: 99%