The arterial tourniquet: pathophysiological consequences and anaesthetic implications

Kam, P. C. A.; Kavanaugh, R.; Yoong, F. F. Y.

doi:10.1046/j.1365-2044.2001.01982.x

Cited by 230 publications

(213 citation statements)

References 106 publications

(124 reference statements)

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“…This method of blood flow interruption, even when performed for 40 min, does not reduce the partial oxygen pressure or increase the potassium levels of dorsalis pedis arterial blood, and no patients have experienced any complications, such as necrosis resulting from lower limb ischemia. A tourniquet used at the time of surgery for arms and legs can cause incomplete ischemia by using air pressure to block circulation, and according to a previous report, injury to the muscles can be minimized if the ejection time is within 90 min 20. Therefore, surgery can be performed safely if incomplete ischemia from CIABO is within 60 min.…”

Section: Discussionmentioning

confidence: 99%

Study of the utility and problems of common iliac artery balloon occlusion for placenta previa with accreta

Ono

Murayama

Era

et al. 2018

J of Obstet and Gynaecol

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AimsWe investigated whether common iliac artery balloon occlusion (CIABO) was effective for decreasing blood loss during cesarean hysterectomy (CH) in patients with placenta previa with accreta and was safe for mothers and fetuses.MethodsOf the 67 patients who underwent CH for placenta previa with accreta at our facility from 1985 to 2014, 57 patients were eligible for the study. The amount of intraoperative bleeding during CH was compared between three groups: surgery without blood flow occlusion (13 patients), internal iliac artery ligation (15 patients) and CIABO (29 patients). Additionally, multivariate analysis was performed to assess risk factors for massive bleeding during CH.ResultsThe mean blood loss in the CIABO group (2027 ± 1638 mL) was significantly lower than in the other two groups (3787 ± 2936 mL in the no occlusion, 4175 ± 1921 mL in the internal iliac artery ligation group; P < 0.05). Multivariate analysis showed that spontaneous placental detachment during surgery (odds ratio [OR] 49.174, 95% confidence interval [CI] 4.98–1763.67), a history of ≥ 2 cesarean sections (OR 9.226, 95% CI 1.07–231.15) and no use of CIABO (OR 26.403, 95% CI 3.20–645.17) were significantly related to massive bleeding during surgery. There was no case of necrosis resulting from ischemia. The mean radiation dose during balloon placement never exceeded the threshold value for fetal exposure.ConclusionBleeding during CH for placenta previa with accreta can be decreased by CIABO. This study also confirmed the safety of CIABO in regard to maternal lower limb ischemia and fetal radiation exposure during balloon placement.

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Section: Discussionmentioning

confidence: 99%

Study of the utility and problems of common iliac artery balloon occlusion for placenta previa with accreta

Ono

Murayama

Era

et al. 2018

J of Obstet and Gynaecol

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“…Currently, there are no clear or widely accepted guidelines on the use of tourniquet in both adult and pediatric settings 1, 3, 5. Most authors agree that limiting the tourniquet time to 2 h is considered ideal 1, 3.…”

Section: Discussionmentioning

confidence: 99%

“…While the lowest effective inflation pressure needed for a bloodless field had been advocated, it is still common practice among orthopedic surgeons to inflate the tourniquet to fixed pressures, for example, 250 mmHg for the upper limb and 300 mmHg for the lower limb 1. Such practices subject patients to higher than necessary inflationary pressures 1, 3, 5 (Also refer to Table S1). …”

Section: Discussionmentioning

confidence: 99%

Tourniquet‐induced common peroneal nerve injury in a pediatric patient after knee arthroscopy – raising the red flag

Saw

Hee

2017

Clinical Case Reports

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“…It's found that the tourniquet pain incidence is more common in lower limb surgery and associated with increasing patient age and the surgery duration [7]. Many theories state that tourniquet pain is predominantly mediated by unmyelinated, slowly conducting C-fibres which are affected to a less extent by the compression of tourniquet inflation than larger fibres [8].…”

Section: Introductionmentioning

confidence: 99%

The Effect of Different Regional Blocks: Combined Femoral-Sciatic, Spinal and Epidural Blocks on the Different Side Effects of Arterial Tourniquet in Patients Undergoing Lower Limb Orthopedic Surgeries —A Randomized Controlled Trail

Omar¹,

Elhamid²,

Rady³

et al. 2017

OJAnes

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Background: Pneumatic arterial tourniquet is a very commonly used technique in limb surgeries to provide bloodless field to facilitate dissection and decrease blood loss. However, arterial tourniquet has many deleterious effects including hemodynamic changes, serum lactate and potassium level changes and tourniquet-induced pain which sometimes can be severe and intolerable. Aim of the study: To evaluate the effect of different regional blocks: femoralsciatic, spinal and epidural blocks on serum lactate and potassium levels and the degree of arterial tourniquet-induced pain in patients undergoing lower limb orthopedic surgeries. Methods: 60 patients underwent lower limb orthopedic surgery with application of tourniquet for duration not more than 90 minutes. Patients were assigned randomly to one of three groups (20 each) Group I had sciatic-femoral block, Group II: patients had spinal anesthesia and Group III: patients had epidural anesthesia. Intraoperative hemodynamics, changes in serum potassium and lactate levels and tourniquet pain after tourniquet inflation & deflation, were recorded. Results: There was no statistically significant difference among the three groups regarding tourniquet pain after tourniquet inflation (p = 0.872) and deflation (p = 0.902), and regarding serum levels changes of potassium (p = 0.067) and lactate (p = 0.051). However, each group showed statistically significant increase in post deflation tourniquet pain (p = 0.003, 0.002, 0.003, in groups F, S, E respectively) and serum potassium (p = 0.004, 0.006, 0.000, in groups F, S, E respectively) and lactate levels (p = 0.004, 0.000, 0.000, in groups F, S, E respectively) when compared to the pre-deflation values, and the increase was 89directly proportional to the duration of tourniquet. Conclusion: the three different types of anesthesia (femoral-sciatic, spinal and epidural block) have the same effect on serum lactate and potassium levels and the degree of tourniquet pain, which were related to the duration of tourniquet inflation.

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The arterial tourniquet: pathophysiological consequences and anaesthetic implications

Cited by 230 publications

References 106 publications

Study of the utility and problems of common iliac artery balloon occlusion for placenta previa with accreta

Study of the utility and problems of common iliac artery balloon occlusion for placenta previa with accreta

Tourniquet‐induced common peroneal nerve injury in a pediatric patient after knee arthroscopy – raising the red flag

The Effect of Different Regional Blocks: Combined Femoral-Sciatic, Spinal and Epidural Blocks on the Different Side Effects of Arterial Tourniquet in Patients Undergoing Lower Limb Orthopedic Surgeries —A Randomized Controlled Trail

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