Use of a tourniquet in patients with sickle-cell disease

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

doi:10.1007/bf03009313

Cited by 62 publications

(14 citation statements)

References 16 publications

(8 reference statements)

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“…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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“…Oxygenation has to be strictly controlled and hypoxia needs to be avoided. Acidosis has to be controlled and bicarbonate is used to reverse it . Mild alkalosis induced by bicarbonate therapy has sometimes been advocated for, mostly older articles .…”

Section: Resultsmentioning

confidence: 99%

Perioperative care of children with sickle cell disease: A systematic review and clinical recommendations

et al. 2019

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Children with sickle cell disease (SCD) require specific perioperative care, and clinical practice in this area remains poorly defined. We aimed to conduct a systematic, PRISMA-based review of the literature, available clinical guidelines and practice recommendations. We also aimed to extract any valuable information for the "best of available-evidence"-based prevention of perioperative adverse events in children with SCD, and highlight the most urgent priorities in clinical research. As data sources, USWe also included institutional, consortia and expert group guidelines. Included were reports/guidelines in English, French, German, and Italian. Excluded were reports on obstetrical and fetal management. We identified 202 reports/guidelines fulfilling the criteria outlined above. A majority focused on visceral, cardiovascular and orthopedic surgery procedures, and only five were multicenter randomized controlled trials and two prospective randomized studies. After grading of the quality of the evidence, the extracted data was summarized into clinical recommendations for daily practice. Additionally, we designed a risk-grading algorithm to identify contexts likely to be associated with adverse outcomes. In conclusion, we provide a systematic PRISMA-based review of the existing literature and ancillary practice and delineate a set of clinical recommendations and priorities for research.

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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: 98%

“…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 (11–13) 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%