Effect Of Tourniquet Research Articles

Uterine Artery Tourniquet Versus Vaginal Misoprostol to Decrease Blood Loss during Transabdominal Myomectomy

Background: Uterine fibroids are tumor of the smooth muscles and the connective tissue of the uterus. They are considered to be the most common benign tumor of the pelvis. Conservative surgery remains the main approach for management of uterine myomas. Myomectomy is considered to be an important option for women who desire future childbearing or simply want to preserve their uterus. Objective: The aim of the study was to compare between the effect of pericervical uterine artery tourniquet (surgical) and perioperative vaginal misoprostol (medical) regarding their efficacy to decrease blood loss during trans- abdominal myomectomy. Methods: Prospective randomized controlled clinical trial. The study was approved by the Ethical Research Committee. The study was conducted in Obstetrics and Gynecology Department, Zagazig University Hospital. The study included 36 women with symptomatic myomas randomized into Group A included 18 patients who underwent uterine artery tourniquet and Group B included 18 patients who received single dose of 400 μg vaginal misoprostol one-hour before surgery. Results: The present study showed that there was statistically significant difference between both groups regarding intra-operative blood loss, operative time, the need for blood transfusion and amount of fluid within the post-operative drain. Conclusion: Pericervical mechanical tourniquet in comparison with pre-operative vaginal misoprostol is more effective method in; reducing both intra-operative and post-operative blood loss, and shortening of operative time during transa-bdominal myomectomy.

Effect of pneumatic tourniquet on perioperative blood loss in total knee arthroplasty

To evaluate the effect of pneumatic tourniquet on perioperative period of total knee arthroplasty (TKA). The perioperative period data of 116 patients over 60 years old with severe knee osteoarthritis treated with TKA between January 2018 and January 2019 were retrospectively analyzed. According to whether pneumatic tourniquet was used during operation, the patients were divided into trial group (49 cases, pneumatic tourniquet was not used during operation) and control group (67 cases, pneumatic tourniquet was used during operation). There was no significant difference in gender, age, body mass index, lesion side, disease duration, and preoperative hemoglobin between the two groups ( P>0.05). The operation time, actual total blood loss, overt blood loss, hidden blood loss, and percentage of hidden blood loss, knee swelling at 3 days after operation, and range of motion of knee at 2 weeks after operation were recorded and compared between the two groups. The operation time of the trial group was significantly longer than that of the control group ( t=14.013, P=0.000). The actual total blood loss, hidden blood loss, and percentage of hidden blood loss in the trial group were significantly lower than those in the control group ( P<0.05); there was no significant difference in the overt blood loss between the two groups ( t=-1.293, P=0.200). The knee swelling degree in the trial group was significantly slighter than that in the control group at 3 days after operation, and the range of motion of knee in the trial group was significantly better than that in the control group at 2 weeks after operation ( P<0.05). Pneumatic tourniquet can reduce the operation time of TKA significantly. However, it may increase the hidden blood loss and knee swelling, and negatively impact the recovery of knee function in the early postoperative stage of TKA.

Penile hair strangulation: A prodigious cause of pediatric agitation.

Penile hair strangulation is secondary to a hair tourniquet effect. Albeit a rare presentation in pediatric emergency units, penile hair strangulation must be cautiously noted in any penile pain and edema, to avoid inevitable damage to external genitalia, including penile necrosis, urethrocutaneous fistula, and even amputation.

Prospective Randomized Study of the Combined Effect of Tranexamic Acid and Tourniquet on Blood Loss in Total Knee Replacement

Prospective Randomized Study of the Combined Effect of Tranexamic Acid and Tourniquet on Blood Loss in Total Knee Replacement

Understanding and Optimizing Tourniquet Use During Extremity Surgery.

Tourniquet use during extremity surgery is commonplace and a relatively safe practice. The surgical team's knowledge of the patient history, proper assessment, and indications and contraindications for and risks of tourniquet use can prevent unwanted outcomes. Exploration of these critical areas reinforces perioperative nurses' awareness and understanding of safe tourniquet use. Additionally, a review of the physiological effect of tourniquets on the skin, the body's response to local compression, the risk of vascular compromise, and the effect of the tourniquet on postoperative pain and swelling provides insight into AORN recommended practice guidelines. This article summarizes the indications and assessments for and risks of tourniquet use for patients during extremity surgery. An understanding of these topics can improve surgical outcomes and promote safe perioperative care.

Masimo Perfusion Index Versus Doppler for Tourniquet Effectiveness Monitoring.

In addition to a plethysmograph, Masimo pulse oximeters display a Perfusion Index (PI) value. This study investigated the possible usefulness of PI for monitoring limb tourniquet arterial occlusion. Tactical Ratcheting Medical Tourniquets were applied to the thighs of 15 subjects. Tightening ended at one ratchet-tooth advance beyond Doppler- indicated occlusion. The times and pressures of Doppler and PI signal absences and returns were recorded. Intermittent PI signal error occurred in 149 of 450 runs (PI, 33% versus Doppler, 0%; p < .0001). PI signal loss lagged Doppler-indicated occlusion by 19 ± 15 seconds (mean ± standard deviation, p < .0001). PI Signal Return lagged tourniquet release by 13 ± 7 seconds (Doppler Signal Return took 1 ± 1 seconds following tourniquet release; p < .0001). PI failed to detect early Doppler audible pulse return in 30 of 39 occurrences. The PI available on Masimo pulse oximeters is not appropriate for monitoring limb tourniquet effectiveness.

Tourniquet use is not associated with limb loss following military lower extremity arterial trauma.

The effect of battlefield extremity tourniquet (TK) use on limb salvage and long-term complications following vascular repair is unknown. This study explores the influence of TK use on limb outcomes in military lower extremity arterial injury. The study database includes cases of lower extremity vascular injury from 2004 to 2012 with data recorded until discharge from military service. We analyzed all limbs with at least one named arterial injury from the femoral to the tibial level. Tourniquet (TK) and no TK (NTK) groups were identified. Univariate analyses were performed with significance set at p ≤ 0.05. A total of 455 cases were included, with 254 (56%) having a TK for a median of 60 minutes (8-270 minutes). Explosive injuries (53%) and gunshot wounds (26%) predominated. No difference between TK and NTK was present in presence of fracture, level of arterial injury, type of arterial repair, or concomitant venous injury. More nerve injuries were present in the TK group, and Abbreviated Injury Scale extremity and Mangled Extremity Severity Score tended toward greater injury severity. Amputation and mortality rates did not differ between groups, but the incidence of severe edema, wound infection, and foot drop was higher in the TK group. Vascular above-knee amputation, arterial repair complication, and severe edema were higher in the TK group also (p = 0.10). Tourniquet duration of 60 minutes or longer was not associated with increased amputations, but more rhabdomyolysis was present. Field TK use is associated with wound infection and neurologic compromise but not limb loss. This may be due to a more severe injury profile among TK limbs. Increased TK times may predispose to systemic, but not limb, complications. Therapeutic/care management, level IV.

A new stocking compression system with a low well-defined resting pressure and a high working pressure

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Ultrasound-guided adductor canal block: a cadaver study investigating the effect of a thigh tourniquet

BackgroundPlacement of local anaesthetic within the adductor canal using ultrasonography is an alternative to femoral nerve blocks for postoperative pain relief after knee joint replacement surgery. However, the effect of an inflated thigh tourniquet on the distribution of local anaesthetic within the adductor canal is unknown. The aim of this cadaveric study was to compare the distribution of radio-opaque dye within the adductor canal in the presence or absence of an inflated thigh tourniquet. MethodsBilateral ultrasound-guided adductor canal blocks were performed on the thawed lower limbs of five fresh frozen human cadavers. The left and right lower cadaver limbs were randomised to receive or not receive a thigh tourniquet inflated to 300 mm Hg for 1 h. X-rays with iohexol radio-opaque dye were obtained in four views, and fiducial markers inserted as reference points. Virtual editing technology was used to recreate outlines representing the distribution of the radio-opaque dye and superimpose these on anatomical images. ResultsRadio-opaque dye was distributed on the medial aspect of the thighs with entire and well circumscribed margins. The majority of the radio-opaque dye was confined within the adductor canal. Superior-inferior dye distribution was 315 mm [95% confidence intervals (CI) 289–342] and 264 mm (95% CI 239–289) in the presence and absence of an inflated thigh tourniquet, respectively (diff 95% CI −80.46 to −22.22, P=0.0081). Image analysis using the recreated radio-opaque outlines suggested that the most proximal point of the radio-opaque dye was 100 mm (95% CI 82–117) or 117 mm (95% CI 62–171) below the inguinal ligament in the presence and absence of an inflated thigh tourniquet, respectively (diff 95% CI −38 to 72, P=0.456). ConclusionsApplication and inflation of thigh tourniquets significantly increased the combined superior–inferior dye distribution within the adductor canal of cadaveric limbs. There was insufficient evidence to suggest significant proximal spread of 25 ml of local anaesthetic to involve the motor branches of the femoral nerve. In some patients, the local anaesthetic may reach the popliteal fossa in close approximation to the sciatic nerve.

Systematic review of prehospital tourniquet use in civilian limb trauma.

Military enthusiasm for limb tourniquet use in combat casualty care has resulted in acceptance by the trauma community for use in the prehospital care of civilian limb injuries. To date, there has been no report synthesizing the published data on civilian tourniquet use. The objective of this systematic review was to compile and analyze the content and quality of published data on the civilian use of tourniquets in limb trauma. The MEDLINE database was searched for studies on civilian limb tourniquet use in adults published between 2001 and 2017. Search terms were tourniquet, trauma, and injury. Military reports and case series lacking systematic data collection were excluded. Counts and percentages were aggregated and weighted for analysis. Reports were included from six regional trauma centers and one interregional collaboration (total of 572 cases). One national prehospital database report was included but analyzed separately (2,048 cases). All were retrospective cohort studies without prospective data collection. Three reports defined a primary outcome, two had a nontourniquet control group, and no two articles reported the same variables. Limb injury severity and characteristics were inconsistently and incompletely described across reports, as were tourniquet indications and effectiveness. Arterial injury was reported in two studies and was infrequent among cases of tourniquet use. Mortality was low, and limb-specific complications were infrequent but variably reported. The rapid increase in the civilian use of tourniquets for limb hemorrhage control has occurred without a large amount or high quality of data. Adoption of a multicenter registry with standardized data collection specific to limb trauma and tourniquet use can serve to improve the trauma community's understanding of the safety and effectiveness of tourniquet use in civilian trauma settings. Systematic review, level IV.

Determination of Pneumatic Tourniquet Pressure of Lower Limb by Ultrasonic Doppler.

The aim of this study was to investigate the clinical effect of tourniquet inflation pressure setting by ultrasonic Doppler on lower limb operation. Ninety-six patients with total knee arthroplasty were selected in this study from January 2015 to December 2015. The patients were randomly divided into the study group and the control group with 48 cases in each group. In the control group, the tourniquet pressure is determined by the doctor's request for the patient's condition, but all the tourniquet pressure values should be 80 KPa or less. In the study group, ultrasonic Doppler was used to monitor the popliteal artery blood flow of surgery limb with the maximum systolic velocity in artery as a reference value. The pressure of pneumatic tourniquet gradually increased until the maximum systolic velocity was reduced to 0. At this time, the popliteal artery blood flow was not present. The 2 groups of patients with lower extremity tourniquet pressure, hemostatic effect of intraoperative tourniquet, and the incidence of adverse reaction using tourniquets were observed and recorded. In the study group, the lower extremity tourniquet pressure and the incidence of adverse reaction using tourniquets were all better than that in control group; the difference between 2 groups was significant (P < 0.05). There was no significant difference between the 2 groups in the effect of hemostasis and the time of tourniquet operation (P > 0.05). The method of ultrasonic Doppler setting lower extremity tourniquet pressure during the operation could not only ensure the hemostatic effect, but it could also provide the optimum individual pneumatic tourniquet pressure value for patients. In the meanwhile, it could reduce the incidence of adverse reaction using tourniquets effectively as well as improve the safety of the tourniquet. This method played an important role in the recovery of patients.

Hemorrhagic choroidal melanoma

PurposeTo demonstrate the clinical pathologic correlation in a hemorrhagic choroidal melanoma. ObservationsA 52 year old patient presented with a large choroidal mass associated with vitreous and retinal hemorrhage. The eye was enucleated and histopathology demonstrated epithelioid-type MART1 positive tumor cells consistent with choroidal melanoma. The tumor had broken through Bruch's membrane, which led to localized vascular compression with bleeding into the subretinal space, retina and vitreous. Conclusions and importanceChoroidal melanoma rarely presents with hemorrhage. Tumor rupture through Bruch's membrane may result in a tourniquet effect on the tumor vasculature leading to massive hemorrhage, as in this case. A high level of clinical suspicion is required to make the diagnosis.

Re: Tourniquet Effectiveness When Placed Over the Joint Service Lightweight Integrated Suit Technology.

Re: Tourniquet Effectiveness When Placed Over the Joint Service Lightweight Integrated Suit Technology.

Contribution of the Tourniquet in the Prevention of Haemorrhages during Myomectomies at the University Hospital of Brazzaville

Objective: To check the effectiveness of tourniquet in the prevention of haemorrhage during myomectomies at the University Hospital of Brazzaville. Patients and methods: Analytical cross-sectional study, conducted at the University Hospital of Brazzaville from June 1, 2014 to June 30, 2016. Recruitment was performed by randomly matching each case of myomectomy performed using a tourniquet with two cases of myomectomy without tourniquet (50 cases vs 100 witnesses). We used as a tourniquet, the surgical glove knotted and tightened sufficiently at the level of the isthmus of the uterus to temporarily occlude the uterine arteries to ensure haemostasis lasting no more than one hour. Results: The mean age of the patients was similar in both groups (36, 1 ± 2.2 years vs 36.2 ± 1.9 years, P > 0.05). Menorrhagia was the most common indication of myomectomy in both groups (76% vs. 78% P > 0.05). The mean haemoglobin level of the patients before the myomectomies was 9.03 ± 1.10 g/dl vs 9, 75 ± 1.29 g/dl; P > 0.05. Intraoperative uterine features were similar in size (18 weeks gestation, 14 - 24) and number of myomas (5 vs 4, P > 0.05) in both groups. Polymyomectomy was more common in both groups (76% vs 73%, P > 0.05). Blood loss was reduced in the tourniquet group (90.5 ± 4.6 ml vs 200.4 ± 5.6 ml; P 0.05), as well as the use of blood transfusion (8% vs 50%, P 0.05). Use of the number of sutures was reduced in the group with tourniquet (3 ± 0.2 vs 6 ± 0.2 P 0.05). The duration of the procedure was shorter in the group with tourniquet (51.5 ± 4 min vs 83 ± 7 min, P 0.05). Postoperative mean haemoglobin of patients was no different between the two groups (9.4 ± 0.7 g/dl vs 9.2 ± 0.5, P > 0.05). The overall cost of management was reduced in the group with tourniquet (190,680 ± 1450 F CFA vs 256,800 ± 2350 FCFA; P 0.05). Conclusion: The use of tourniquet during myomectomies significantly reduces blood loss and the use of blood transfusion. We also obtain the notorious reduction in the use of sutures, the duration of interventions, and the overall cost of care. Thus, we encourage the systematic use of tourniquet during myomectomies by laparotomy.

Smartphone-based mobile thermal imaging technology to assess limb perfusion and tourniquet effectiveness under normal and blackout conditions.

Over the past decade, there has been a resurgence of tourniquet use in civilian and military settings. Several key challenges include assessment of limb perfusion and adequacy of tourniquet placement, particularly in the austere or prehospital environments. We investigated the utility of thermal imaging to assess adequacy of tourniquet placement. The FLIR ONE smartphone-based thermal imager was utilized. Ten swine underwent tourniquet placement with no associated hemorrhage (n = 5) or with 40% hemorrhage (n = 5). Experiment 1 simulated proper tourniquet application, experiment 2 had one of two tourniquets inadequately tightened, and experiment 3 had one of two tourniquets inadequately tightened while simulating blackout-combat conditions. Static images were taken at multiple time points up to 30 minutes. Thermal images were then presented to blinded evaluators who assessed adequacy of tourniquet placement. The mean core temperature was 38.3 °C in non-hemorrhaged animals versus 38.2 °C in hemorrhaged animals. Hemorrhaged animals were more hypotensive (p = 0.001), anemic (p < 0.001), vasodilated (p = 0.008), and had a lower cardiac output (p = 0.007) compared to non-hemorrhaged animals. The thermal imaging temperature reading decreased significantly after proper tourniquet placement in all animals, with no difference between hemorrhaged and non-hemorrhaged groups at 30 minutes (p = 0.23). Qualitative thermal image analysis showed clearly visible perfusion differences in all animals between baseline, adequate tourniquet, and inadequate tourniquet in both hemorrhaged and non-hemorrhaged groups. Ninety-eight percent of blinded evaluators (n = 62) correctly identified adequate and inadequate tourniquet placement at 5 minutes. Images in blackout conditions showed no adverse impact on thermal measurements or in the ability to accurately characterize perfusion and tourniquet adequacy. A simple handheld smartphone-based forward looking infrared radiometry device demonstrated a high degree of accuracy, reliability, and ease of use for assessing limb perfusion. Forward looking infrared radiometry also allowed for rapid and reliable identification of adequate tourniquet placement that was not affected by major hemorrhage or blackout conditions.

Post-operative clinical outcomes in patients with or without the use of tourniquet in total knee replacement surgery

Introduction: The use of tourniquet in a total knee replacement (TKR) has been advocated by some researchers across the globe, though the evidence is still lacking. In this study we aimed to assess the effect of using a torniquet in patients undergoing total knee replacement on the post-operative blood drainage and range of movement of the operated knee. Methodology: We included patients who were admitted for undergoing total knee replacement (TKR) surgeries in the Department of Orthopedics at the A.J. Institute of Medical Sciences during the period of November 2014 to May 2016. We included 20 patients who underwent TKR using a tourniquet and 20 age and gender matched control patients who underwent TKR without the use of tourniquet. The cases underwent surgery with tourniquet throughout the surgery at a pressure of 350 mmHg and the control group without tourniquet (inflated only for 20 minutes during cementing). Post-operative drain collection and recovery of range of movements at knee joint on 7th post-operative day were compared using unpaired t-test. p value less than 0.05 was considered statistical significant. Results: At baseline, with respect to the demographic data and pain, both the groups were comparable. A mean of 1009 ± 168 mL drainage was collected in the torniquet group and 628 ± 116.5 mL drainage was collected in patients who were operated without the torniquet (p < 0.001). Range of motion was more at the end of 1 week post-operatively in patients without the use of torniquet (p < 0.01) as compared to patients with torniquet. Conclusions: We compared the effect of tourniquet in patient undergoing total knee replacement. Multi-centric randomized trials are needed to further sustantiate our findings.

Does penile tourniquet application alter bacterial adhesion to rat urethral cells: an in vitro study.

To investigate the effects of penile tourniquet (PT) application on bacterial adhesion to urothelium. Fifty-six rats were allocated into control group (CG), sham group (SG), PT group (PTG). No intervention was applied in CG. A 5mm-length urethral repair was performed in SG and PTG. In PTG, a 10-min duration of PT was applied during the procedure and the tissue oxygenation monitor was used to adjust the same degree of ischemia in all subjects. Samples were examined for wound healing parameters and tissue levels of inflammatory markers, eNOS, e-selectin, and ICAM-1antibodies. The adhesion of Escherichia coli to urothelium was investigated with in vitro adhesion assay. Inflammation was higher and wound healing was worse in SG than CG and in PTG in comparison to CG and SG (p<0.05). The endothelial damage, as shown by eNOS expression, was significantly higher in PTG compared to CG and SG (p<0.05). The staining with ICAM-1 and e-selectin antibodies, showing increased inflammatory response to bacterial adhesion, was significantly higher in PTG compared to CG and SG (p<0.05). In vitro urethral cell proliferation was achieved only in CG and SG revealing significantly increased adhesion in SG compared to CG (p<0.05). The PT application caused endothelial corruption and prevented cell proliferation in cell culture. The PT application does not improve wound healing and increases bacterial adhesion molecules in penile tissue. The in vitro assays showed that PT causes severe endothelial damage and inhibits endothelial cell proliferation.

Pressures secondary to circumferential digital dressings in clay models

Aim: With little manipulation, compression bandages placed circumferentially around the digit can be rolled up the digit, creating a tourniquet effect. The aim of this study was to elucidate the pressures induced by self-adherent bandages applied circumferentially around the fingers.

The Effect of Air Tourniquet on Interleukin-6 Levels in Total Knee Arthroplasty.

Background:Air tourniquet-induced skeletal muscle injury increases the concentrations of some cytokines such as interleukin-6 (IL-6) in plasma. However, the effect of an air tourniquet on the IL-6 concentrations after total knee arthroplasty (TKA) is unclear. We therefore investigated the impact of tourniquet-induced ischemia and reperfusion injury in TKA using the IL-6 level as an index.Methods:Ten patients with primary knee osteoarthrosis who underwent unilateral TKA without an air tourniquet were recruited (Non-tourniquet group). We also selected 10 age- and sex-matched control patients who underwent unilateral TKA with an air tourniquet (Tourniquet group). Venous blood samples were obtained at 3 points; before surgery, 24 h after surgery, and 7 days after surgery.The following factors were compared between the two groups; IL-6, C-reactive protein (CRP), creatine phosphokinase (CPK), the mean white blood cell (WBC) counts, and the maximum daily body temperatures.Results:The IL-6 level at 24 h after surgery was significantly higher than that at any other point (p<0.01). No significant differences were observed in the WBC count, the body temperature, or the CRP, CPK, or IL-6 levels of the two groups at any of the time points.Conclusion:The effect of ischemia and reperfusion due to the use of an air tourniquet on increasing the IL-6 level was much smaller than that induced by surgical stress in TKA.

Effects of Suture and Tourniquet on Intraoperative Kinematics in Navigated Total Knee Arthroplasty

BackgroundTo investigate the effects of suture (soft tissue closure) and air tourniquet use on intraoperative kinematics in navigated total knee arthroplasty. MethodsThe study included 20 patients with varus-type knee osteoarthritis who underwent primary posterior-stabilized total knee arthroplasty using computed tomography (CT)–based navigation. Intraoperative tibiofemoral kinematics from maximum extension to maximum flexion were measured using the computed tomography–based navigation. The measurements were performed 3 times as follows: measurement 1: before suture (tourniquet on), measurement 2: after suture (tourniquet on), and measurement 3: after tourniquet removal. Details of kinematics including knee joint gap, tibiofemoral rotational angles, and anteroposterior (AP) distance between the femur and tibia were compared among the 3 measurements and statistically evaluated. ResultsOn the medial side, there was no significant difference among the 3 measurements in the extension gap, but measurement 1 showed a significantly larger flexion gap compared with the other 2 measurements. On the lateral side, there was no significant difference between the extension and flexion gaps in all measurements. The anteroposterior distance in measurement 1 showed that the femur was positioned significantly more anterior to the tibia at 10° and 20° of flexion compared with the other 2 measurements after suture. There was no significant difference among the 3 measurements in the tibiofemoral rotation angles. ConclusionThese results found that the effect of suture and tourniquet was minimal, and that intraoperative kinematics can effectively evaluate postoperative passive kinematic conditions.