Perioperative Implications of Pneumatic Tourniquets Used During Orthopedic Surgery

Abstract

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.