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

Kumar, Kamal; Railton, Craig; Tawfic, Qutaiba A.

doi:10.4103/0970-9185.168174

Cited by 87 publications

(81 citation statements)

References 41 publications

(64 reference statements)

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“…After review of the timing, it is suspected that this represents a period of hyperalgesia after tourniquet removal. Tourniquets are known to cause discomfort in man, so their use is predominantly restricted to anesthetized patients . Their use in minimally sedated horses can similarly result in painful responses, requiring the use of sedation .…”

Section: Discussionmentioning

confidence: 99%

“…Tourniquets are known to cause discomfort in man, so their use is predominantly restricted to anesthetized patients. 45,46 Their use in minimally sedated horses can similarly result in painful responses, requiring the use of sedation. 38,47 Tourniquet release is reportedly painful in human patients, and painfulness is also suspected in equine patients because of their repetitive limb movements after removal.…”

Section: Discussionmentioning

confidence: 99%

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Synovial butorphanol concentrations and mechanical nociceptive thresholds after intravenous regional limb perfusion in standing sedated horses

et al. 2019

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Objective To determine synovial butorphanol concentrations and mechanical nociceptive threshold (MNT) changes after butorphanol intravenous regional limb perfusion (IVRLP). Study design Experimental Animals Six adult horses. Methods Cephalic IVRLP was performed with 10 mg butorphanol in sedated horses with a wide rubber tourniquet and a total volume of 30 mL. Radiocarpal synovial fluid and serum concentrations along with MNT were evaluated prior to and 0.5, 1, 2, 4, and 6 hours after IVRLP. Butorphanol concentrations were determined with liquid chromatography coupled to tandem mass spectrometry positive electrospray ionization. Results Butorphanol concentrations reached mean (SD) peak concentrations of 9.47 ng/mL (±12.00) in synovial fluid and 3.89 ng/mL (3.29) in serum 30 minutes after IVRLP. Concentrations remained above baseline for 4 hours in synovial fluid (P ≤ .017) and for 2 hours in serum (P ≤ .016). The only difference in MNT was detected 1 hour after IVRLP, when MNT were higher in controls than in treated horses (P = .047). Conclusion Butorphanol IVRLP seemed well tolerated and resulted in measurable levels of butorphanol in the radiocarpal synovial fluid of five of six horses. Clinical significance Intravenous regional limb perfusion appears to be a viable alternative to administer butorphanol, but additional investigation is required to evaluate the dose and local concentrations required for analgesia.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Synovial butorphanol concentrations and mechanical nociceptive thresholds after intravenous regional limb perfusion in standing sedated horses

et al. 2019

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“…Estos efectos ocurren en los 30 minutos posteriores al retiro del torniquete. También se puede observar un aumento del CO 2 espirado, teniendo un máximo 1-3 minutos desde la liberación de la isquemia, retornando a su basal en aproximadamente 10 a 13 minutos 7 , todos estos signos podrían simular una HM.…”

Section: Discussionunclassified

Hipertermia maligna: A propósito de un caso

Guzmán¹,

Aleuanlli²,

Gallegos³

2017

Rev Chil Anest

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Malignant hyperthermia (MH) is a rare neuromuscular hereditary disorder, triggered in susceptible individuals by exposure to inhalational agents or succinylcholine and manifested as a hypermetabolic state. We report the case of a 22 years old male patient anesthetized with Desflurane in whom MH was suspected because of unexplained increased levels of End-Tidal carbon dioxide. Dantrolene was administered with good response. Respiratory acidosis and hyperkalemia were also detected but could be easily controlled. The postoperative period was uneventful with the exception of a superficial venous thrombosis at the dantrolene's injection site. The patient was discharged eight days after the episode without sequela. Successful management of a malignant hyperthemia episode must include: early suspicion, asking for help and early treatment with dantrolene. ResumenLa Hipertermia Maligna es un trastorno neuromuscular hereditario infrecuente, manifestado por un estado hipermetabólico desencadenado en individuos susceptibles por la exposición a anestésicos halogenados o Succinilcolina. Se reporta el caso de un hombre de 22 años anestesiado con Desflurano, en quien el diagnóstico de Hipertermia Maligna se sospechó por la presencia de elevación inexplicada del CO 2 espirado, que respondió a la suspensión del Desflurano y administración de Dantroleno. Se observó además hiperkalemia y acidosis respiratoria, que fueron fácilmente compensadas. La evolución postoperatoria fue satisfactoria, a excepción de una trombosis venosa superficial en el sitio de inyección del Dantroleno. El paciente fue dado de alta al 8 avo día postoperatorio, sin secuelas. Las claves del manejo exitoso de un episodio de hipertermia maligna están en: Sospecha precoz, solicitar ayuda e inició rápido del tratamiento con Dantroleno.

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“…Tourniquet, which is widely used in surgeries of the extremities to induce a bloodless surgical eld, can cause hemodynamic reaction, ischemia, and reperfusion injury, secondary to its in ation and de ation [1,2]. The systemic effects associated with tourniquet depend on the tourniquet phase, duration of tourniquet application, size of the ischemic area, type of anesthesia administered, and underlying cardiovascular condition of the patient [3].…”

Section: Introductionmentioning

confidence: 99%

The impact of dexmedetomidine on tourniquet induced systemic effects in total knee arthroplasty under spinal anesthesia: a prospective randomized, double-blinded study.

Lee

et al. 2020

Preprint

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Background: Clinical studies on the impact of dexmedetomidine on tourniquet-induced systemic effects have been inconsistent. We investigated the impact of dexmedetomidine on tourniquet-induced systemic effects including pain outcomes in patients undergoing total knee arthroplasty under spinal anesthesia. Methods: Eighty patients were randomly assigned to either control (CON) or dexmedetomidine (DEX) group. DEX group received an intravenous loading dose of 0.5 µg/ kg DEX over 10 minutes, followed by a continuous infusion of 0.5 µg/ kg/h from 10 minutes before the start of surgery until completion. The CON group received the same calculated volume of normal saline. Pain outcomes and metabolic and coagulative changes after tourniquet application and after tourniquet release were investigated.Results: The frequency of fentanyl administration postoperatively, patient-controlled analgesia (PCA) volume at 24 hours postoperatively, total PCA volume consumed in 48 hours postoperatively, and VAS score for pain at 24 and 48 hours postoperatively were significantly lower in the DEX group than in the CON group.Ten minutes after tourniquet release, the DEX group showed significantly higher pH and lower lactate level than those in the CON group. Antithrombin III activity and body temperature 10 minutes after tourniquet release were significantly lower in the DEX group than in the CON group. Ca2+, K+, HCO3-, base excess, and PCO2 levels 10 minutes after tourniquet release were not significantly different between the two groups.Conclusion: We showed that DEX attenuated pain and hemodynamic, metabolic, and coagulative effects induced by tourniquet. However, these metabolic and coagulative changes were within normal limits. Therefore, DEX could be used as an analgesic adjuvant, but should not be considered for routine use to prevent the systemic effects induced by tourniquet use.

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

Cited by 87 publications

References 41 publications

Synovial butorphanol concentrations and mechanical nociceptive thresholds after intravenous regional limb perfusion in standing sedated horses

Synovial butorphanol concentrations and mechanical nociceptive thresholds after intravenous regional limb perfusion in standing sedated horses

Hipertermia maligna: A propósito de un caso

The impact of dexmedetomidine on tourniquet induced systemic effects in total knee arthroplasty under spinal anesthesia: a prospective randomized, double-blinded study.

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