The pneumatic tourniquet: mechanical, ischaemia–reperfusion and systemic effects

Abstract

The pneumatic tourniquet is frequently used for upper and lower limb surgery to reduce bleeding, improve visualisation of important structures and expedite surgical procedures. Despite advances in technology, localised tissue damage secondary to cuff compression, ischaemia-reperfusion injuries and systemic complications still occur. The combination of these problems may affect outcome and contribute to prolonged hospitalisation. Use of the correct pneumatic tourniquet cuff size and a patient-specific cuff pressure with careful control of the duration of inflation may help reduce the incidence of these injuries. The efficacy of ischaemic preconditioning or postconditioning, and experimental treatments such as free radical scavenging, and use of nitric oxide synthetase inhibitors on endothelial dysfunction, systemic neutrophil activation and coagulation reactions needs to be established.

Effects of Tourniquet Pressure on Rehabilitation Outcomes in Patients Undergoing Total Knee Arthroplasty

“…Nonetheless, Worland et al (1997) showed an important correlation between tourniquet pressure and thigh pain in the immediate postoperative period. Pain relief in the immediate postoperative period following TKA is crucial in facilitating early recovery ( Estebe et al, 2011 ;Worland et al, 1997 ). In our study, there was a signifi cant reduction in postoperative pain in patients using a tourniquet with minimal infl ation pressure.…”

Curcumin and dexmedetomidine prevents oxidative stress and renal injury in hind limb ischemia/reperfusion injury in a rat model

“…In previous studies, the deleterious effects of these factors on various cell functions were shown, including mitochondrial oxidative phosphorylation, ATP depletion, activation of protein kinases, phosphatases, proteases, lipases, and nucleases, which might lead to loss of several cellular function and integrity. 24 This cellular dysfunction and disintegrity might play a role in the etiopathology of remote organ damage including liver, kidney and lung in lower limb ischemia-reperfusion injury. [3][4][5]16 The kidneys are particularly involved in the remote alteration phenomenon following skeletal muscle ischemia-reperfusion injuries.…”

Does Tourniquet Time or Pressure Contribute to Intracranial Pressure Increase following Tourniquet Application?

“…In orthopedic surgery, tourniquets are often used to reduce hemorrhage in the operative field, improve the visualization of important structures, and expedite the surgical procedure [3]. All pneumatic tourniquets including the new generation of automated devices can lead to a wide range of complications, from minor and self-limiting to life-threatening [1].…”

“…The use of a tourniquet in orthopedic interventions provides a bloodless surgical site, providing protection against surgical complications and shortening the operation time, and consequently shortening the length of hospital stay [3]. …”