457 Tourniquet Pressures in Orthopaedic Surgery - Is the Standard 250mmHg Safe?

Abstract

Abstract Aim To determine safe levels of tourniquet inflation pressures in trauma and orthopaedic surgery. Method Data was collected on 150 patients retrospectively from the intraoperative and anaesthetic records of patients undergoing trauma and elective orthopaedic surgery at a single site. Data collected included demographic data, tourniquet inflation pressures and maximum intraoperative systolic blood pressures. British Orthopaedic Association (BOA) standards for safe intraoperative tourniquet use were used to determine safe tourniquet inflation pressures. Results The average maximum intraoperative systolic blood pressure was 125mmHg. In 134 cases (91%) the tourniquet pressure used was 250mmHg. Of the cases studied 54% of upper limb and 33% of lower limb tourniquets were overinflated when compared with BOA standards. Given the average maximum intraoperative systolic blood pressure, standard tourniquet inflation pressures of 200mmHg for upper limbs and 225mmHg for lower limbs should be used in preference to the more commonly used standard used pressure of 250mmHg. Conclusions All patients should ideally have an individual tourniquet pressure set based on their systolic blood pressure. However, if a standard pressure is to be used, values of 200mmHg for upper limbs and 225mmHg for lower limbs should be used in preference to 250mmHg as appears to commonly used currently.