Use of a Tourniquet in Patients with Sickle-Cell Disease

Adu-Gyamfi, Yaw; Sankaran-Kutty, M.; Marwa, S.

doi:10.1097/00132586-199308000-00026

Cited by 4 publications

(6 citation statements)

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“…There have been reports of crises precipitated by the use of tourniquets in surgery in sickle cell disease and, conversely, successful procedures carried out with minimal adverse events. Clinical decisions regarding tourniquet use should be made on the basis of risk versus benefit to the patient, and supplemented with careful exsanguination technique and good general principles of sickle cell patient management [1,75,84].…”

Section: Special Medical Considerationsmentioning

confidence: 99%

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: Special Medical Considerationsmentioning

confidence: 99%

Tourniquet Use in Upper Limb Surgery

Oragui

Parsons

White

et al. 2010

Hand (New York, N,Y.)

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“…Adu‐Gyamfi et al . [96] reported the use of tourniquets in 15 patients with the sickle cell gene, 12 of whom were homozygous for the disease. The mean tourniquet time was 61 min and all patients made an uneventful recovery.…”

Section: Sickle Cell Diseasementioning

confidence: 99%

The arterial tourniquet: pathophysiological consequences and anaesthetic implications

2001

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SummaryThe arterial tourniquet is widely used in upper and lower extremity surgery and in intravenous regional anaesthesia. The local and systemic physiological effects and the anaesthetic implications are reviewed. Localised complications result from either tissue compression beneath the cuff or tissue ischaemia distal to the tourniquet. Systemic effects are related to the inflation or deflation of the tourniquet. Safe working guidelines for the application of an arterial tourniquet have not been clearly defined.

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“…It is our understanding that it is currently recommended that there is careful exsanguination of the limb before tourniquet application (4), which should reduce stasis of blood. In the study by Adu-Gyamfi et al (11), all patients had limb exsanguination with an Esmarch bandage with no adverse sequelae. In summary, this case serves to illustrate two valuable points of interest: the role of regional anesthesia in children with complex medical histories and the successful use of tourniquets in sickle cell disease without any adverse sequelae.…”

Section: Discussionmentioning

confidence: 95%

“…Flow reduction, hypothermia, acidosis and hypoxia of the limb may cause sickling in the reperfusion period (2). However, tourniquets have been safely used (11,12,13), provided optimum acid-base status and oxygenation are maintained throughout the procedure. One must balance the risk of precipitating a sickle crisis with a tourniquet, against the benefit of providing a bloodless field, with reduced blood loss and shorter operating time.…”

Section: Discussionmentioning

confidence: 99%

“…One must balance the risk of precipitating a sickle crisis with a tourniquet, against the benefit of providing a bloodless field, with reduced blood loss and shorter operating time. Keeping this evidence (11)(12)(13) in mind, the decision to use a tourniquet was based on the belief that there was more benefit than risk involved; especially this was a bilateral procedure necessitating precise anatomical location of several nerves and tendons in the ankle joints and feet. High concentrations of fetal hemoglobin also prevent formation of Hb S polymers (4).…”

Section: Discussionmentioning

confidence: 99%

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