Surgical Tourniquets in Orthopaedics

Noordin, Shahryar; McEwen, James A.; Kragh, John F; Eisen, Andrew; Masri, Bassam A.

doi:10.2106/jbjs.i.00634

Cited by 182 publications

(167 citation statements)

References 29 publications

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“…Indicated tourniquets should be assessed for proper placement and effective hemorrhage control. Inappropriately placed tourniquets should be removed in a controlled setting to prevent potential complications associated with tourniquet use [12]. Pressure dressings or bandages may then be placed as indicated.…”

Section: Orthopedic Evaluation and Extremity Triage Principlesmentioning

confidence: 99%

2014 Fort Hood, Texas, mass casualty incident: reviews and perspectives

Strommen

Waterman

Mitchell

et al. 2015

Curr Rev Musculoskelet Med

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On April 2, 2014, in Fort Hood, Texas, an active shooter incident occurred where four active duty soldiers were tragically killed. Active shooter incidents are becoming alarmingly more frequent over the last decade in the USA. The authors provide a detailed account of the events that occurred within the hospital and an evaluation of the triage decisions made on that day. A detailed review of mass casualty preparedness and the general approach to triage processes are also described.

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Section: Orthopedic Evaluation and Extremity Triage Principlesmentioning

confidence: 99%

2014 Fort Hood, Texas, mass casualty incident: reviews and perspectives

Strommen

Waterman

Mitchell

et al. 2015

Curr Rev Musculoskelet Med

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“…An important issue that must be addressed in such procedures is the prevention of bleeding during and after the surgery (1). The purpose of local hemostasis is to stop bleeding from a severed or lacerated vessel (2,3). Hemostasis includes mechanical, chemical (pharmacological), and heat types (2)(3)(4).…”

Section: Introductionmentioning

confidence: 99%

“…The purpose of local hemostasis is to stop bleeding from a severed or lacerated vessel (2,3). Hemostasis includes mechanical, chemical (pharmacological), and heat types (2)(3)(4). Generally, a clamp or ligature is used to create permanent hemostasis in a lacerated vessel.…”

Section: Introductionmentioning

confidence: 99%

Comparative Effects of Standard and Bipolar Cauterization in Pediatric Orthopedic Surgery

Baghdadi

Arti

Zargarbashi

2018

J Orthop Spine Trauma

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Background: One of the most important issues in the orthopedic surgery, especially pediatric orthopedic surgery, is to prevent or reduce bleeding during the operating time. The goal of local hemostasis is to prevent or blockade the flow of blood from a disrupted vessel that has been incised or transected. Objectives: The aim of this study was to compare the effects of standard (monopolar) and bipolar electrocauterization during the pediatric orthopedic surgery. Methods: In this study, 60 patients were enrolled for the pediatric orthopedic surgery and classified into two groups. Group I included 30 patients undergoing hemostasis with standard electrocautery and group II comprised 30 patients undergoing hemostasis with bipolar electrocautery. The intraoperative bleeding was measured with sterile absorbent gauze. Every gauze could absorb 20 mL of blood. Then, bleeding was compared between the groups.

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“…Systemic effects are usually related to inflation and deflation of the tourniquet, whereas local effects and complications may result from either direct pressure to the underlying tissues or ischemia in the tissues distal to the tourniquet 2 . The systemic effects include, increase in blood pressure and heart rate (tourni-quet hypertension or pain), temperature reduction in the non-perfused limb, production of anaerobic metabolites and hypercoagulability 1,2 . The local effects of tourniquet inflation include nerve, muscle, vascular and skin injury.…”

mentioning

confidence: 99%

“…After inflation for 30-60 minutes, patients may develop increases in heart rate systolic and diastolic arterial blood pressure that persist until tourniquet deflation, a phenomenon known as 'tourniquet pain or hypertension' 4,5 . Tourniquet pain is defined as a vague, dull pain in the limb associated with an increase in heart rate and blood pressure 1,4 . Prolonged tourniquet inflation is associated with a gradual increase in arterial blood pressure.…”

mentioning

confidence: 99%

A randomized controlled trial to assess the effect of a ketamine infusion on tourniquet hypertension during general anaesthesia in patients undergoing upper and lower limb surgery

Ongaya¹,

Mung’ayi²,

Sharif³

et al. 2017

Afr H. Sci.

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Background: Tourniquet hypertension arising from tourniquet inflation remains a primary concern to the anaesthetist. One drug commonly used to manage tourniquet hypertension is ketamine. No studies have examined the effect of ketamine on tourniquet hypertension for a period of more than one hour or an infusion of the same. Objective: To compare the effect of an intravenous infusion of ketamine versus placebo on tourniquet induced hypertension in patients undergoing upper and lower limb surgery under general anaesthesia. Methods: Forty six adult patients scheduled for upper and lower limb surgery under general anaesthesia were randomized into two equal groups. The ketamine group received an intravenous bolus of 0.1mg/kg of ketamine followed by an infusion of 2ug/kg/min. The saline group received an intravenous bolus of physiological saline followed by an infusion of saline. All the patients were reviewed post-operatively. Data of the baseline characteristics, haemodynamic changes, post-tourniquet pain and side effects were collected. If post-tourniquet pain was present post-operatively, a visual analogue scale (VAS) was used to assess its severity. Results: 46 patients successfully completed the trial. There were no significant differences between the groups for baseline patient demographics. The incidence of tourniquet hypertension was higher in the saline group (26.1%) compared with ketamine group (4.6%) with a 95% confidence interval. The difference was shown to be statistically significant ('P'<0.05). There was an increase in systolic blood pressure after 60 minutes of tourniquet inflation in the saline group but the difference was not statistically significant('P'>0.866). There were no significant differences between the groups as regards diastolic blood pressure and heart rate. VAS scores did not differ between the two groups. Statistically, there was no difference found between the two groups. Side effects were minimal in the ketamine group whilst in the saline group, nausea and vomiting were predominant but were also not statistically significant. Conclusion: Based on the results of this study,there was a difference in the proportion of tourniquet hypertension between the ketamine and saline groups for patients undergoing upper and lower limb orthopaedic surgery under general anaesthesia. Keywords: Randomized controlled trial, effect of a ketamine infusion, tourniquet hypertension, general anaesthesia, upper and lower limb surgery.

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Surgical Tourniquets in Orthopaedics

Cited by 182 publications

References 29 publications

2014 Fort Hood, Texas, mass casualty incident: reviews and perspectives

2014 Fort Hood, Texas, mass casualty incident: reviews and perspectives

Comparative Effects of Standard and Bipolar Cauterization in Pediatric Orthopedic Surgery

A randomized controlled trial to assess the effect of a ketamine infusion on tourniquet hypertension during general anaesthesia in patients undergoing upper and lower limb surgery

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