Summary The STOP‐BANG questionnaire screens for obstructive sleep apnoea. We retrospectively analysed the independent association of pre‐operative variables with postoperative critical care admission using multivariable logistic regression for patients undergoing elective surgery from January to December 2011. Of 5432 patients, 338 (6.2%) were admitted postoperatively to the critical care unit. In multivariate analysis, the odds ratios (95% CI) for critical care admission were: 2.2 (1.1–4.6), p = 0.037; 3.2 (1.2–8.1), p = 0.017; and 5.1 (1.8–14.9), p = 0.002, for STOP‐BANG scores of 4, 5 and ≥ 6, respectively. The odds ratio was also independently increased for: each year of age, 1.015 (1.004–1.026), p = 0.019; asthma, 1.6 (1.1–2.4), p = 0.016; obstructive sleep apnoea, 3.2 (1.9–5.6), p < 0.001; and for ASA physical status 2, 3 and ≥ 4, 2.1 (1.4–3.3), 6.5 (3.9–11.0), 6.3 (2.9–13.8), respectively, p < 0.001 for all.

Use of a tourniquet for performing surgery in order to create a bloodless surgical field and reduce blood loss has been in use for many years. Tourniquets may fail perioperatively for various reasons, leading to ongoing bleeding. An important cause of tourniquet failure is calcification of the underlying artery. A patient undergoing total knee replacement surgery in whom the tourniquet failed, secondary to femoral artery calcification is reported. The implications of tourniquet use in patients with arterial calcification, including acute distal ischaemia, aneurysm formation and vessel fracture will be discussed. Recommendations include: thorough vascular assessment of all patients preoperatively, awareness of the possibility of tourniquet failure particularly in vasculopaths, and the provision of an alternative perioperative management plan such as use of a cell saver device, should the tourniquet fail.

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