Bilateral passive leg raising attenuates and delays tourniquet deflation-induced hypotension and tachycardia under spinal anaesthesia

Huang, Go-Shine; Wang, Chih‐Chien; Hu, Meihua; Cherng, Chen‐Hwan; Lee, Meei-Shyuan; Tsai, Chien‐Sung; Chan, Wai Hong; Hsieh, Xhang-Xian; Lin, Leou-Chyr

doi:10.1097/eja.0b013e32836286e3

Cited by 7 publications

(8 citation statements)

References 19 publications

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“…There was a 15.1% decrease in MAP in controls, while the decrease was 4.3% in the leg raising group. Therefore, it helped to maintain hemodynamic stability after deflation compared to controls [13] . This effect could be explained by three mechanisms; first of all, rising the leg helps to move blood from the lower limb vasculature, by the effect of gravity, to the intrathoracic veins, leading to an increase in cardiac preload [14,15] .…”

Section: Discussionmentioning

confidence: 97%

Comparison between the Effect of Trendelenburg 20 Degree and Straight Leg Raising 45 Degree Positions on The Hemodynamics After Tourniquet Deflation in Knee Arthroscopy

sonbol

Ghareeb

2021

International Journal of Medical Arts

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Background: Deflation of the pneumatic tourniquet after orthopedic surgery is associated with multiple cardiovascular adverse effects [hypotension and tachycardia]. Trendelenburg position or passive leg raising [PLR] are commonly used as the initial treatment of shock and hypotension Aim of the work: To compare between Trendelenburg position 20˚ and passive leg raising 45° regarding the incidence of posttourniquet deflation cardiovascular adverse effects in patients undergoing unilateral knee arthroscopy. Patients and methods: This prospective study included 98 cases that underwent unilateral knee arthroscopy. Patients were randomly allocated into two groups; group [1] included 49 cases who were exposed to the Trendelenburg position after deflation, and group [2] included the remaining cases who had the straight leg raising test after deflation. Mean arterial pressure, heart rate, and need for vasoactive substances were recorded.Results: No significant difference was noticed between the two groups regarding demographic variables, heart rate before tourniquet deflation, and one-minute after its deflation. However, there was a significant difference between the same groups on the subsequent readings apart from the last one. Also, group [1] showed significantly higher mean arterial pressure [MAP] compared to group [2] after deflation. Hypotension was more significantly encountered in group [2], and thus ephedrine requirements were increased. Conclusion:Trendelenburg position appears to be more efficacious when compared to the straight leg raising, regarding the prevention of cardiovascular adverse effects associated with deflation.

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Section: Discussionmentioning

confidence: 97%

Comparison between the Effect of Trendelenburg 20 Degree and Straight Leg Raising 45 Degree Positions on The Hemodynamics After Tourniquet Deflation in Knee Arthroscopy

sonbol

Ghareeb

2021

International Journal of Medical Arts

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“…Beside pressure injury, thrombosis and systemic congestion, the ischemia induced by tourniquet resulting in anaerobic metabolism with accumulation of metabolites, waste products and acids resulting in systemic acidosis, tachycardia, hyperlactemia, hyperkalemia, vasodilatation and hypotension [2]. These drawbacks are augmented by sudden venous pooling of blood in the limb after tourniquet deflation, resulting in a serious hemodynamic instability, tissue hypoxia and surgical field infection on the long term [8].…”

Section: Discussionmentioning

confidence: 99%

Gradual versus intermittent release of tourniquet in total knee arthroplasty surgery, effects on hemodynamics and acid base parameters: a prospective randomized controlled study

Elbadrawy

Aboelela

2021

Egyptian Journal of Anaesthesia

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Background: Using of the pneumatic tourniquet is a common practice in many surgeries. While it creates bloodless field, it is not free of complications. Tourniquet deflation is a critical stage, greatly affecting hemodynamics. Till now, no strict guidelines have been developed for managing such a procedure. Methods: Sixty patients, >40 years old, undergoing total knee arthroplasty enrolled in this study. Tourniquet deflation done over 3 min before complete release, either by gradual pressure release 50 mmHg/30 s in gradual deflation (G) group or by three cycles of deflationreinflation (deflation for 10 s and reinflation for 50 s) in intermittent deflation (I) group. Results: No significant difference was found regarding patient demographics and basal data. Mean arterial pressure was significantly lower in G group at times of deflation and post deflation for 5 min (P values 0.011, 0.023, 0.024, 0.001, and 0.013, respectively). Also, heart rate and acid base parameters were more stable and convergent to basal data in I group. Conclusion:Compared to gradual deflation, intermittent deflation of tourniquet in middle and old aged, total knee arthroplasty patients resulted in more stability in hemodynamics and acid base parameters.

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“…The blood pressure may drop considerably and compromise global tissue perfusion. The hypotension should be corrected with the infusion of fluids and/or vasoactive drugs [11,12].…”

Section: Discussionmentioning

confidence: 99%

Perioperative Implications of Pneumatic Tourniquets Used During Orthopedic Surgery

Silva¹

2014

JACCOA

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effects associated with orthopedic surgery that uses a pneumatic tourniquet during the procedure. Materials and MethodsA prospective cohort study, over one year, was conducted at the surgical center of a tertiary care hospital, after approval was received from the Ethics Committee of the institution; all participants signed an informed consent.Only patients undergoing elective arthroscopic knee surgery that were over 18 years of age and required the use of a pneumatic tourniquet for the procedure were included in the study. Patients with diabetes, those with any infectious process, patients with cardiac problems or those with prior renal or hepatic insufficiency were excluded, because their underlying disease could influence the final findings of this study; specifically, their condition could cause acidosis. In order to determine the effects of the tourniquet on patient outcomes, these patients, with medical problems, were not included in this study.To standardize the collection of data, the ASA (American Society of Anesthesiology) classification was used to determine patient severity as well as prior surgery comorbidities. Ringer lactate solution was used for volemic resuscitation and only the pneumatic tourniquet was used as a limb tourniquet during the procedure.The patients were evaluated at three different times: before AbstractObjectives: The use of pneumatic tourniquets to prevent major bleeding is well established for orthopedic surgery; however, it is not without complications. The goal of this study was to evaluate the possible perioperative consequences among patients with use of such tourniquets during orthopedic surgery.Method: This prospective cohort included: patients undergoing arthroscopic knee surgery and were over 18. Patients with diabetes, cardiac disease and those with renal or hepatic insufficiency were excluded. Before beginning the surgery (T1), immediately after surgery (T2) and 12 hours later (T3) after tourniquet de-insufflations, clinical and laboratory data from the patients were collected.Results: Forty patients were included. The outcome assessment showed that the clinical and laboratory data collected at: T1, T2 and T3 showed statistically significant differences, mainly in T2, for mean arterial pressure, base deficits, PaCO 2 , lactate, potassium and CPK. The tourniquet time showed a direct correlation with the length of hospital stay (R 2 = 0.76; P < 0.001); a longer tourniquet time was correlated with a longer hospital stay. Conclusion:Careful perioperative monitoring must follow orthopedic surgery that requires the use of pneumatic tourniquets. The results of this study showed important clinical and laboratory alterations that might be associated with increased surgical risk.

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Bilateral passive leg raising attenuates and delays tourniquet deflation-induced hypotension and tachycardia under spinal anaesthesia

Abstract: ClinicalTrials.gov number NCT01592669.

Cited by 7 publications

References 19 publications

Comparison between the Effect of Trendelenburg 20 Degree and Straight Leg Raising 45 Degree Positions on The Hemodynamics After Tourniquet Deflation in Knee Arthroscopy

Comparison between the Effect of Trendelenburg 20 Degree and Straight Leg Raising 45 Degree Positions on The Hemodynamics After Tourniquet Deflation in Knee Arthroscopy

Gradual versus intermittent release of tourniquet in total knee arthroplasty surgery, effects on hemodynamics and acid base parameters: a prospective randomized controlled study

Perioperative Implications of Pneumatic Tourniquets Used During Orthopedic Surgery

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