Tourniquet Research Paper

DISCUSSION

The use of a pneumatic tourniquet may be associated with local complications including limb paralysis, nerve, muscle, vessel, skin damages and other injuries such as compartment syndrome (1-3). Clinical and experimental studies showed that nerve conduction abnormalities and muscle dysfunctions occur after 30-45 minutes of tourniquet application in more than 70 % of lower extremity surgeries which persisted up to 6 months and correlated with impaired postoperative function and delayed recovery after tourniquet use. Moreover, it has been suggested that incidence of these abnormalities may be underreported (4).These abnormalities have been attributed to length of ischemia period as well as excessive inflation pressures used. As a goal,

Regardless of SBP or limb circumference Pauers et al. used standard 250 mmHg and reported that adequate hemostasis was achieved in all cases (8). Several studies investigated the soft tissue pressure distribution under a tourniquet cuff with limbs of human cadavers and dogs. These studies showed that tissue pressures are consistently less than tourniquet pressures inversely with the circumference of the limb and emphasized that the main factors affecting optimal tourniquet pressures include the girth of the limb and the systolic blood pressure of the patient suggesting that a tissue pressure of above systolic blood pressure of the patient will be adequate to occlude blood flow to the limb (9-12). On the other hand, the patient’s systolic blood pressure may rise during surgery and conventional tourniquet systems which remain on the initial setting pressure throughout the procedure cannot respond to these hemodynamic changes. In this case, the inflation pressure should be adjusted manually in order to prevent oozing from an increase in systolic blood pressure or not to apply unnecessary high inflation pressures from a decrease in systolic blood pressure. Since this needs an additional time and work for the personnel, a fixed safety margin of 100-150 mmHg has been suggested to add the patient’s

Using these new adaptive systems, Ischii et al obtained excellent bloodless field almost in all their patients (20, 21). On the other hand, the mean maximal tourniquet inflation pressures were 233 ± 18 and 235 ± 27 mmHg in Ishii’s studies higher than our results. The main reasons of these high inflation pressures were the additional pressure of 100 mmHg added on SBP and the SBP changes during the surgical procedures and the mean maximal change of 28±13 and 33±22 mmHg in SPB during tourniquet periods. Moreover, their tourniquet system the blood pressure measurement was set to cycle automatically with 2.5 minutes of interval (20, 21). Since, peripheral nerve injuries due to automatic blood pressure monitors even with 3 minutes interval have been reported before, the extremity in which the non-invasive blood pressure measurements done might be also exposed to risk