Tourniquet Research Articles

Effect of different concentrations of tranexamic acid on blood loss after total knee arthroplasty: A randomized controlled clinical trial

Objective To investigate the effect and safety of intraarticular injection of tranexamic acid (TXA) at 2 concentrations on blood loss after total knee arthroplasty (TKA). Methods For this single blinded prospective randomised controlled trial, according to our inclusion and exclusion criteria we chose 24 patients diagnosed with degenerative joint disease who would receive bilateral TKA from October 2014 through July 2015. Comparisons were conducted between their bilateral knees. The knees were randomized into 2 groups to receive intraarticular injection of TXA at concentrations of either 15 g/L or 30 g/L before the tourniquet was released post-surgery. The TXA concentrations for each pair of knees were randomized by flipping a coin. The drainage, range of motion (ROM), visual analogue scale (VAS) and thigh circumference for each knee were recorded post-surgery. Blood routine examination and prothrombin time test were conducted for each patient at pre-surgery and 1, 3 and 5 days post-surgery. Vascular B-ultrasonography was performed for all the bilateral lower limbs at 5 days and one month post-surgery to assess incidence of thrombosis. Results The drainage for the 50 mL sides (65.4±33.4 mL) was significantly less than for the 100 mL sides (86.1±53.6 mL) (t=-3.873, P=0.001). There were no significant differences between the 50 mL and 100 mL sides regarding knee ROM (14.9°±3.1° versus 15.3°±3.3°), VAS (6.2±0.9 versus 6.0±1.0), or thigh circumference (46.8±3.0 cm versus 46.9±2.6 cm) (P>0.05). In this cohort, the post-surgery prothrombin time was significantly longer than the pre-surgery one (P<0.05). No deep infection, pulmonary embolism or deep vein thrombosis was observed in our trial. Conclusions Intraarticular injection of TXA can reduce blood loss after TKA and is safe. A higher concentration of TXA is more effective in decreasing post-surgery hemorrhage. Key words: Tranexamic acid; Arthroplasty, replacement, knee; Postoperative hemorrhage; Embolism and thrombosis

Effect of maternal limb ischemic preconditioning on expression of caspase-3 in neurons in brain tissues after reoxygenation in fetal rats with intrauterine distress

Objective To investigate the effect of maternal limb ischemic preconditioning on the expression of caspase-3 in neurons in brain tissues after reoxygenation in the fetal rats with intrauterine distress. Methods Forty Sprague-Dawley rats at 19 days of gestation were randomly divided into 4 groups (n=10 each) using a random number table: sham operation group (group S), limb ischemic preconditioning group (group LIP), fetal rat distress group (group FD), and limb ischemic preconditioning+ fetal rat distress group (group LIP+ FD). Distress/reoxygenation model was established by clamping the uterine and ovarian arteries and veins with a micro-artery clamp for 15 min followed by removal of the clamp to permit reperfusion.Limb ischemic preconditioning was induced by 3 cycles of occlusion of the lower limb blood flow at the site of the right groin for 5 min with a tourniquet followed by 5 min unclamping.In group LIP+ FD, the uterine and ovarian arteries and veins were clamped, and limb ischemic preconditioning was performed at the same time.Cesarean section was performed on 2 days after the end of treatments in each group, and the fetal rat mortality rate was calculated.The fetal rats alive were sacrificed, and the hippocampi were isolated for determination of neuronal apoptosis(by TUNEL) and expression of caspase-3 protein and mRNA (by Western blot and real-time reverse transcriptase polymerase chain reaction, respectively) in hippocampal CA1 region.Apoptosis index was calculated. Results Compared with group S, the fetal rat mortality rate and apoptosis index were significantly increased, and the expression of caspase-3 protein and mRNA in hippocampal CA1 region was significantly up-regulated in FD and LIP+ FD groups(P 0.05). Compared with group FD, the fetal rat mortality rate and apoptosis index were significantly decreased, and the expression of caspase-3 protein and mRNA in hippocampal CA1 region was significantly down-regulated in group LIP+ FD (P<0.05 or 0.01). Conclusion The mechanism by which maternal limb ischemic preconditioning inhibits apoptosis in neurons after reoxygenation is related to down-regulation of the expression of caspase-3 in the fetal rats with intrauterine distress. Key words: Extremities; Ischemic preconditioning; Caspase 3; Fetal distress; Reperfusion injury; Brain

Research advances on perioperative blood management for total knee arthroplasty

Acute blood loss anemia is the most common surgical complication of total knee arthroplasty. Currently, allogeneic transfusion has been the major method of managing postoperative anemia. Although allogeneic transfusion can correct anaemic condition temporarily, it can lead to severe complications, such as postoperative infection, prolongation of physical recovery, increased length of hospital stay, and increased mortality. Perioperative blood management can effectively reduce blood loss and transfusion rate. These strategies mainly focus on three parts: therapy for anemia and autologous blood donation before operation; application of a tourniquet, antifibrinolytic drugs, topical hemostatic agents and acute normovolemic hemodilution during operation; selection of reinfusion systems, restrictive transfusion thresholds, drainage and knee position after operation. Perioperative blood management should run throughout the perioperative period, which mainly aims at reducing blood loss and blood transfusion, improving prognosis, promoting the postoperative recovery and lowering the medical cost. Depending on the actual situations of patients, surgeons should combine different major characteristics of each strategy and weigh the pros and cons to make effective and reasonable individualized treatment plan.

Influence of Thigh Tourniquet Release on Cardiovascular Parameters While Operated Limb in Elevated Position

Background: Release of pneumatic tourniquet causes hypotension, tachycardia and compensatory increase in cardiac index. Objectives: This study was conducted to assess the effect of tourniquet release on cardiovascular parameters while operated leg in 20 degrees up position. Design: Prospective randomized comparative study. Setting: University hospital. Methods: This study included 60 patients, ASA I scheduled for meniscal surgery through knee arthroscopy under general anesthesia. Patients were divided into two groups: group C (n=30) in which tourniquet was deflated with leg in neutral position while group S (n=30) tourniquet was released with leg in 20 degrees up position. Cardiovascular parameters displayed by ccNexfin monitor eg cardiac output (COP), cardiac index (CI), stroke volume (SV), mean arterial pressure (MAP), systemic vascular resistance (SVR), heart rate (HR), as well as arterial blood gas measurements. End tidal carbon dioxide, respiratory rate, end tidal sevoflurane and bispectral index values were also recorded before and after tourniquet deflation. Results: There was significant decrease in MAP and SVR at all intervals post deflation in group C compared to group S whereas COP, CI, SV and HR were significantly increased in group C post deflation compared to group S. But there were no significant differences between groups regarding metabolic and respiratory parameters. Conclusion: Tourniquet deflation while leg in elevated position caused attenuation in both the decrease in MAP, SVR and the compensatory increase in CI, COP and SV. Limitations: This study is limited by its small sample size.

Effect of dexmedetomidine added to ropivacaine administered locally on prevention of tourniquet-related hypertension in patients undergoing total knee arthroplast

Objective To investigate the effect of dexmedetomidine added to ropivacaine administered locally on prevention of tourniquet-related hypertension in the patients undergoing total knee arthroplast. Methods Ninety patients of both sexes, aged 58-74 yr, weighing 60-78 kg, of American Society of Anesthesiologists physical statusⅠ-Ⅲ, scheduled for elective unilateral total knee arthroplast, were randomly divided into 3 groups (n=30 each) using a random number table: ropivacaine group (group R), dexmedetomidine added to ropivacaine administered locally group (group D+ R), and dexmedetomidine administered intravenously + ropivacaine group (group Div+ R). Femoral nerve block: 0.5% ropivacaine 15 ml was injected in group R; the mixture (15 ml) of 0.5% ropivacaine 20 ml plus dexmedetomidine 60 μg was injected in group D+ R; 0.5% ropivacaine 15 ml was injected in group Div+ R.Lateral femoral cutaneous nerve block: 0.5% ropivacaine 5 ml was injected in group R; the mixture 5 ml was injected in group D+ R; 0.5% ropivacaine 5 ml was injected in group Div+ R.General anesthesia was induced after the end of nerve block.In group Div+ R, dexmedetomidine was infused as a bolus of 0.5 μg/kg over 10 min starting from anesthesia induction, followed by an infusion of 0.4 μg·kg-1·h-1 until 30 min before the end of surgery.A tourniquet was applied and inflated (266-304 mmHg) within 90 min.Before induction of anesthesia (T0), and at 0, 15, 30, 45, 60, 75 and 90 min after the tourniquet was inflated (T1-7), mean arterial pressure and heart rate were recorded.The occurrence of hypertension, hypotension, tachycardia and bradycardia was recorded when the tourniquet was inflated.Agitation was assessed and scored after removal of the endotracheal tube.The time for recovery of breathing, emergence time, and time for removal of the endotracheal tube were recorded. Results Compared with group R, the mean arterial pressure and heart rate were significantly decreased at T1-7 in D+ R and Div+ R groups, the incidence of hypertension and tachycardia was decreased, the incidence of bradycardia was increased, and agitation score was decreased in D+ R and Div+ R groups (P 0.05). There was no significant difference in the time for recovery of breathing, emergence time, and time for removal of the endotracheal tube between the three groups (P>0.05). Conclusion Dexmedetomidine added to ropivacaine administered locally can exert effect on prevention of tourniquet-related hypertension in the patients undergoing total knee arthroplast, and the effect is similar to that of dexmedetomidine administered intravenously. Key words: Dexmedetomidine; Amides; Tourniquets; Hypertension

Comparative study between the pinless navigation and the articular surface mounted (ASM) navigation in total knee arthroplasty: Radiographic results and early clinical outcomes

Introduction: There were reports showed pinless navigation and articular surface mounted navigation in total knee arthroplasty (TKA) produces better results in term of radiographic outcomes when compared to conventional techniques. However, there was no comparative study between these two systems. Objective: To compare the radiographic results and early clinical outcomes between two systems. Methods: We collect data from all patients underwent TKA using either system from 1 January 2014 to 30 September 2014. We excluded the patient whom underwent navigation on tibia or femur only; the patients with pre-op deviation of mechanical axis more than 15 degrees, and the patients with extra-articular deformity. Radiographic outcomes included pre and post-operative alignment, and post-operative prosthesis alignment in coronal and sagittal plane. Clinical outcomes included demographic data, knee score and functional score, tourniquet time, blood loss, and complications. Results: 83 patients were included (43 pinless group, 40 ASM group). There was no statistical significant difference in the mean of age, BMI, pre-operative deformity, and pre-operative knee score, functional score, blood loss, and post-operative knee score and functional score. However in term of radiographic results, the mean post-operative correction of mechanical axis of pinless navigation was varus 1.1+/-2.16 degree while mean of ASM navigation was varus 0.01+/-1.88 degree. The difference was statistically significant with p-value less than 0.05. Percentage of radiographic outlier of pinless group was 13.95% while ASM group was 2.5%. Conclusion: The ASM navigation showed better result in term of post-operative correction of mechanical axis, which due to the ability to verify bone resection after the bone was resected. This feature could be beneficial in future development of this simple CAS system.

Application of hypothermal tourniquet in hemostasis about radial artery blood sampling of elderly patients

Objective To explore the hemostatic effects of the hypothermal tourniquet on elderly patients after radial arterial blood collection. Methods A total of 200 patients (over seventy years older) after blood collection were divided into experimental group and control group by random number table. The hypothermal tourniquets was introduced for hemostasis in the experimental group while the traditional pressure hemostasis was used in the control group. We compared the pain level and skin status at the pricking point. Results The pain score of pricking point in the control group was (5.6±1.506) compared with (1.9±1.287) in the experimental group (t=6.40, P<0.01). The incidences of bleeding, ecchymosis, hematoma, numbness of limb at pricking point in the experimental group were 2.0%, 3.0%, 2.0%, 6.0%, while they were 10.0%, 12.0%, 11.0%, 21.0% in the control group (χ2=5.67, 5.84, 6.66, 9.63; P<0.05). Conclusions The application of hypothermal tourniquet is a effective method to stop bleeding among elderly after radial arterial blood collection. Key words: Elderly; Radial arterial blood collection; Compression; Hemostasis; Hypothermal

Application of tourniquet with polymer padding in upper limb surgery

Objective To design a new tourniquet cuff padding made of polymer composite materials, and to analyze the effects of preventing the tourniquet-induced skin injury with the new cuff padding during orthopedic operations. Methods A total of 60 patients, who used pneumatic tourniquet to stop bleeding, undergoing elective upper limb operations were randomly assigned to treatment group (n=30) and control group (n=30). In the treatment group, the limb underneath the pneumatic tourniquet was protected by a layer of Polymer padding while in the control group the limb was protected by a layer of gypsum paper. The effects of the two types of padding on controlling bleeding and preventing skin post-operative injuries were observed and analyzed. Results In the experimental group, the skin reaction rate was lower than the rate of the control group (χ2=19.186 8, P<0.01). The good feedback from surgeon was good occupying 27 cases in the treatment group and 21 cases in the control group for stopping bleeding (χ2=16.734 3, P<0.01). Conclusions Using the Polymer protective padding can reduce the incidence of complications in the skin underneath the tourniquet and improve the effects of bleeding-control. Key words: Pressure, tourniquet; Hospital, Orthopedics; Upper limb, surgery; Skin impairment

Effects of unified surgical scheme for wounds on the treatment outcome of patients with extensive deep burn

To investigate the effects of unified surgical scheme for wounds on the outcome of patients with extensive deep partial-thickness to full-thickness (briefly referred to as deep) burn. One hundred and thirty-seven patients with extensive deep burn hospitalized from July 2007 to November 2012 underwent unified surgery according to area of deep wound (unified scheme group, US). Among them, 57 patients with deep wound area less than 51% TBSA received escharectomy or tangential excision by stages followed by autologous mesh skin grafting; 52 patients with deep wound area from 51% to 80% TBSA underwent escharectomy or tangential excision by stages followed by autologous mesh skin grafting and/or small skin grafting, or escharectomy or tangential excision followed by large sheet of allogeneic skin covering plus autologous mesh skin grafting and/or small skin grafting after the removal of allogeneic skin; 28 patients with deep wound area larger than 80% TBSA received escharectomy or tangential excision by stages followed by autologous microskin grafting plus coverage of large sheet of allogeneic skin, or escharectomy or tangential excision followed by small autologous skin grafting and/or intermingled grafting with small autologous and/or allogeneic skin. Another 120 patients with extensive deep burn hospitalized from January 2002 to June 2007 who did not receive unified surgical scheme were included as control group (C). Except for the surgical methods in group US, in 53 patients with deep wound area less than 51% TBSA in group C escharectomy or tangential excision was performed followed by autologous small skin grafting; in 40 patients with deep wound area from 51% to 80% TBSA in group C escharectomy or tangential excision was performed followed by autologous microskin grafting plus large sheet of allogeneic skin covering, or escharectomy or tangential excision followed by large sheet of allogeneic skin embedded with stamp-like autologous skin; in 27 patients with deep wound area larger than 80% TBSA in group C escharectomy or tangential excision was performed followed by covering with large sheet of allogeneic skin embedded with stamp-like autologous skin without intermingled grafting with small autologous and allogeneic skin in group US. In group US, escharectomy of full-thickness wound in extremities was performed with the use of tourniquet in every patient; saline containing adrenaline was subcutaneously injected when performing escharectomy or tangential excision over the trunk and skin excision; normal skin and healed superficial-thickness wound were used as donor sites for several times of skin excision. The baseline condition of patients and their treatment in the aspects of fluid resuscitation, nutrition support, anti-inflammation, and organ function support were similar between the two groups. The mortality and incidence of complications of all patients and wound healing time and times of surgery of healed patients were compared between the two groups. Data were processed with independent sample t test, Mann-Whitney U test, and Fisher's exact test. (1) Both the mortality and the incidence of complications of patients with deep wound area less than 51% TBSA in group US were 0, which were close to those of group C (with P values above 0.05). The number of times of surgery of healed patients with deep wound area less than 51% TBSA in group US was 2.4 ± 0.9, which was obviously fewer than that of group C (3.5 ± 1.8, U=-5.085, P<0.001), but with wound healing time close to that of group C (U=-1.480, P>0.05). (2) Both the mortality and the incidence of complications of patients with deep wound area from 51% to 80% TBSA in group US were 0, which were significantly lower than those of group C [both as 20.0% (8/40), with P values below 0.01]. The number of times of surgery and wound healing time of healed patients with deep wound area from 51% to 80% TBSA in group US were respectively 3.0 ± 1.0 and (43 ± 13) d, which were obviously fewer or shorter than those in group C [4.2 ± 2.3 and (61 ± 34) d, with U values respectively -2.491 and -2.186, P values below 0.05]. (3) Both the mortality and the incidence of complications of patients with deep wound area larger than 80% TBSA in group US were 25.0% (7/28), which were close to those of group C [both as 25.9% (7/27), with P values above 0.05]. The number of times of surgery and wound healing time of healed patients with deep wound area larger than 80% TBSA in group US were close to those of group C (with U values respectively -0.276 and -0.369, P values above 0.05). Unified surgical scheme can indirectly decrease the mortality and the incidence of complications of burn patients with deep wound area from 51% to 80% TBSA; it can reduce times of surgery of healed patients of this type and shorten their wound healing time.

Comparison between two methods of bandaging and hemostasis for puncture point after coronary intervention through radial artery

Objective To investigate the efficiency of chitosan hemostatic dressing combined radial artery hemostasis device in patients after transradial coronary intervention. Method Six hundred consecutive patients after transradial coronary intervention were selected and randomly divided into the experimental group and the control group according to the hospital number, there were 300 cases in each group. Single pneumatic tourniquet was used in the control group, while the chitosan hemostatic dressing combined with pneumatic tourniquet was used in the experimental group. Hemostasis consumption time, incidence of bleeding, ecchymosis and radial arterial occlusion were compared between two groups. Results There was no significant difference in the incidence of skin ecchymosis between two groups,P>0.05. The hemostasis consumption time and the incidence of bleeding,early radial arterial occlusion and chronic radial arterial occlusion were (127.6±33.0)min, 7.0%(21/300), 5.7%(17/300), 4.0%(12/300)in the experimental group and (181.6±32.2)min, 20.0%(60/300), 11.7%(35/300), 9.0%(27/300)in the control group,t or χ2 values were 20.258, 21.708, 6.822, 6.170 respectively, and there were significant differences,P<0.01 or <0.05. Conclusion In patients after transradial coronary intervention, the application of chitosan hemostatic dressing combined with pneumatic tourniquet is safer and more effective than using pneumatic tourniquet alone. Key words: Chitosan; Radial artery; Hemostatic techniques; Treatment outcome

Efficiency of ring butterfly sewing in lower uterine segment aided with tourniquet in treating pernicious placenta previa combined with placenta percreta

Objective To investigate the efficiency of ring butterfly sewing in lower uterine segment aided with tourniquet in treating pernicious placenta previa combined with placenta percreta. Methods Twelve pregnant women diagnosed with pernicious placenta previa combined with placenta percreta by prenatal ultrasound in Peking University First Hospital from April 1, 2012 to November 30, 2014, were enrolled. All of them received elective cesarean delivery using ring butterfly sewing in lower uterine segment aided with tourniquet. The efficiency of this novel technique, in term of blood loss and vital signs during operation, blood transfusion, and postoperative recovery, was analyzed. Results Twelve cases were diagnosed with placenta percreta during operation, with placenta invading the perimetrium in seven cases and urinary bladder being involved in one case. Ring butterfly sewing in lower uterine segment aided with tourniquet during elective cesarean delivery was all successful in the 12 cases. The median amount of blood loss was 1 000(400-2 000) ml during operation and the amount of blood loss was lower than 1 000 ml in three cases. Two cases received no blood transfusion, and the median blood transfusion in the other 10 cases were 400(400-1 200) ml. The mean operation time was (75±22) min (43-131) min. Eleven cases had normal lochia and temperature after operation and the other one had placenta invading urinary bladder and partial placenta in situ, and developed fever at day 3 after operation, but recovered after antibiotic treatment, and no placenta tissue was seen by ultrasound at day 59 after operation. Conclusions The ring butterfly sewing in lower uterine segment aided with tourniquet is highly effective for the pernicious placenta previa combined with placenta percreta, and it is a simple, fast and fertility sparing technique with low blood loss and without usage of special equipment. Key words: Placenta previa; Placenta percreta; Tourniquets; Ligation; Suture techniques; Gynecologic surgical procedures

Evidence in Support of Tourniquet Use in Major Limb Trauma

For traumatic limb hemorrhage, tourniquet use is common sense. To quantify its benefit, investigators reviewed data from a registry of injured U.S. soldiers in Afghanistan and Iraq. In an analysis of patients with major limb trauma who reached a hospital alive and received blood transfusion, …

Fracture of an Osteochondroma of Humerus by Arm Tourniquet Inflated to Measure Blood Pressure in Pediatric Patient With Radial Nerve Neuropraxia

Pedicle fracture of an osteochondroma with radial nerve neuropraxia is a rare complication. The aim of this study was to evaluate a case of fractured osteochondroma after the arm tourniquet inflated to measure blood pressure that caused low energy pedicle fracture with radial nerve neuropraxia in a child. The patient was treated with total excision without complication, and its presentation was similar to that of low energy pedicle fracture with radial nerve neuropraxia. J Med Cases. 2015;6(1):17-19 doi: http://dx.doi.org/10.14740/jmc2015w

Effects of dexmedetomidine preconditioning attenuating remote lung injury of lower limb ischemia-reperfusion

To investigate the effects of dexmedetomidine preconditioning attenuating remote lung injury of lower limb ischemia-reperfusion. Sixty patients form Central Hospital of Cangzhou scheduled for lower limb operation with tourniquet from January 2014 to June 2014. Lumbar plexus combined with sciatic nerve block was performed guided by a nerve stimulator in both groups. All patients were randomly assigned to two groups, conventional general anesthesia group (R group, n = 30) and dexmedetomidine preconditioning group (Pre-Dex group, n = 30). In the group Pre-Dex, a dexmedetomidine intravenous infusion was started at a dose of 0.125 ml/kg (4 µg/ml) for 10 minutes before using tourniquet, whereas group R received an equivalent volume of normal saline. Blood samples were taken in femoral vein for 4 ml. Monocytes TLR4 expression and interleukin-6(IL-6), interleukin-8(IL-8), tumor necrosis factor-α(TNF-α) level were determinated 15 minute before tourniquet inflation(T(1)), 15 minute (T(2)), 2 h(T(3)), 6 h(T(4))and 24 h(T(5)) after tourniquet release. Artery blood gas analysis, respiratory index and oxygenation index were measured by drawing off femoral artery for 2 ml. Compare with T(1), RI in group R was higher at T(4) and OI was lower at T(3-5) (P < 0.01), and there were no significant differences in group Pre-Dex at T(2)-T(5) about RI and OI (P > 0.05); IL-8,IL-6 level at T(3)-T(5) and TNF-α level at T(2)-T(5) in group R were significantly higher. IL-8,IL-6 level at T(3)-T(4) and TNF-α level at T(2)-T(4) in group Pre-Dex were higher. Monocytes TLR4 expression was higher in group R at T(3)-T(4) (P < 0.05). Compare with group R, RI in group Pre-Dex was lower and OI was higher at T(4) (P < 0.05); IL-8, IL-6 level at T(3)-T(5) and TNF-α level at T(2)-T(4) in group Pre-Dex was significantly lower (P < 0.05). Monocytes TLR4 expression was lower in group Pre-Dex at T(3)-T(5) (P < 0.05). IL-6, IL-8 level had positive correlation with TLR4 and RI ((r = 0.673, 0.647, 0.521, 0.457, P < 0.01 ), but had negative correlation with OI in group R (r = -0.613, -0.578, P < 0.01). Dexmedetomidine preconditioning attenuate remote lung injury of lower limb ischemia-reperfusion, and the mechanism may be related to down-regulation of monocytes TLR4 expression and degradation of IL-6, IL-8 and TNF-α level.

Efficacies of treating large area third-degree burns by tangential excision and skin grafting for subcutaneous tissue wounds

To explore the efficacies of treating patients with large area third-degree burns by tangential excision and skin grafting for subcutaneous tissue wounds. From January 2002 to December 2013, the medical records were retrospectively reviewed for 31 consecutive adult patients with a third-degree burn area exceeding 70% and undergoing tangential excision and skin grafting on subcutaneous tissue wound (TESGSTW) for the first time within 7 days postburn at Burn Center, Affiliated Jinan Central Hospital, Shandong University. For 31 patients, wounds with relative integrity eschar underwent TESGSTW by stages. Tourniquet was not used in some extremities. The relevant clinical data including patient condition on admission, causes of death, blood loss of tangential excision wound, surgical procedures and efficacies in cured group were analyzed. Average age, burn total area and third-degree burn area of 31 patients were (32.4 ± 12.8) years, (89.0 ± 6.2)% and (80.4 ± 7.6)% respectively. There were inhalation injury (n = 25, 80.6%) and early-stage shock before hospitalization (n = 22, 71.0%). Among 18 cured ones (58.1%), 2 patients had a third-degree burn area ≥ 90%. And 13 patients (41.9%) died and 10 of them died at 4 to 19 days postburn. Burn area was a risk factor of burn mortality. Sepsis and multiple organ dysfunction syndrome (MODS) were major mortality causes. Four patients died from early-stage sepsis. Within 14 days postburn, average blood loss volume per 1% tangential excision area in non-tourniquet group was slightly higher than that in the tourniquet group, but the difference was insignificant. For 18 cured patients, TESGSTW were performed 41 times. For 14 patients (77.8%), TESGSTW was performed twice. The average time of the first tangential excision was (4.1 ± 0.6) days postburn, the time interval between the first two tangential excisions was (6.4 ± 2.0) days, the first tangential excision area (33.8 ± 7.6)% and accumulated tangential excision area (58.4 ± 10.8)%. Among 39 operations within 14 days postburn, refrigerated allogeneic or fresh porcine skin grafts were involved 33 times (84.6%). The wounds were fresh and bleeding after peeling 5 to 7 days postoperation. The time of allogeneic (xenogeneic) skin removal or rejection, recipient bed debridement and auto-skin grafting was (18.0 ± 4.8) days postoperation. And the auto-skin survival rate was (89.5 ± 9.5)%. Wound infection occurred 5 times in 4 patients. During a follow-up period of 6-108 months after TESGSTW, healed wound surface was plump and contraction relatively mild and non-prone to ulceration. And both extensibility and sensitivity were good. TESGSTW is safe for treating patients with large area third-degree burns. And its short and long-term outcomes are favorable.

Effect of dexmedetomidine on lung injury induced by extremity ischemia-reperfusion

Objective To evaluate the effect of dexmedetomidine on lung injury induced by extremity ischemia-reperfusion.Methods Forty patients,aged 18-60 yr,with body mass index of 20-25 kg/m2,of ASA physical status Ⅰ or Ⅱ,with 1 h ≤ predicted duration of surgery ≤ 1.5 h,were randomly divided into 2 groups (n =20 each) using a random number table:control group (group C) and dexmedetomidine group (group D).In groupD,dexmedetomidine 1 (g/kg was infused intravenously for 10 min,followed by continuous infusion of dexmedetomidine at 0.5 μg· kg-1 · h-1 until the end of the surgery,while in group C the equal volume of normal saline was given instead.Immediately before induction of anesthesia (T1,baseline),at 60 min after tourniquet was inflated (T2) and at 30 min,2 h and 6 h after tourniquet release (T3-5),blood samples were collected from the radial artery for blood gas analysis and for measurement of the levels of plasma interleukin-6 (IL-6),IL-8,tumor necrosis factor-α (TNF-α),malondialdehyde (MDA) and superoxide dismutase (SOD),and arterial partial pressure of oxygen (PaO2) and partial pressure of carbon dioxide (PaCO2) were recorded.Alveolar-arterial oxygen difference (A-aDO2) and respiratory index (RI) were calculated.Results Compared with group C,PaO2 was significantly increased at T5,and A-aDO2 and RI at T5,the levels of plasma IL-6 and IL-8 were decreased at T4,5 and the levels of plasma TNF-α,MDA and SOD were decreased at T3-5 in group D.Conclusion Dexmedetomidine can attenuate lung injury induced by extremity ischemia/reperfusion via inhibiting inflammatory responses and lipid peroxidation. Key words: Dexmedetomidine ; Reperfusion injury ; Extremities ; Respiratory distress syndrome, adult

Congenital trigger finger.

A 4-month-old boy, first in birth order, born by spontaneous vaginal birth at full term, was brought with a complaint of flexion deformity of the left ring finger. His mother stated that the deformity had been noticed by the primary care physician during routine neonatal check-up at birth. There was no history of peri-natal trauma, infections, or rheumatologic / metabolic disorders and development milestones had been achieved normally. No prior intervention had been done for the complaint. On physical examination, there was triggering of left ring finger (4th digit) with a snap on flexion to about 60° (Fig 1 A & B). Palpation revealed a non-tender, firm nodule over the palmar side of the metacarpophalangeal joints of the affected finger. There was no other anomaly. Plain radiographs of both hands were normal. Parents were counselled and attached to the services of hand physiotherapy/orthotics division where a nocturnal splint was advised with passive daytime, home exercises of finger flexion/extension. However, due to lack of compliance, no benefit could be appreciated after follow up at 8 weeks of presentation. Hence, after informed consent, surgical release of A-1 pulley was undertaken under general anaesthesia and proximal tourniquet control (Fig. 1C). The deformity was markedly reduced after surgical release (Fig. 1D), but the final outcome could not be ascertained due to loss of patient to follow-up.

The wide-awake hand surgery technique and its applications

Objective To introduce the wide-awake technique in hand surgery and to evaluate its effectiveness and clinical application.Methods Between October 2012 and April 2013,the wide-awake technique was applied in 16 hand surgery cases.The number of patients with surgery of the bone was 5 while the other 11 patients only had soft tissue operations.The visual analogue score (VAS) was used to evaluate preoperative injection pain,intraoperative and postoperative pain.The active movement and surgical field bleeding were evaluated during the operation.The anesthesia complications and blood supply of the skin in the surgical area were observed after the operation.Results The wide-awake technique in hand surgery did not restrict the active movement while achieving good haemostasis without tourniquet use.During the preoperative injections the patients only felt pain of the first poke (VAS 2 to 4).There was no pain in soft tissue procedures (VAS 0).There was light pain in procedures involving manipulation of bones (VAS 0 to 3).The severity of postoperative pain varied (VAS 0 to 7).No anesthetic complications and skin necrosis were noted postoperatively.Conclusion The wide-awake technique is safe and effective.It allows intraoperative monitoring of motor function.It is cost effective and can be carried out in outpatient settings. Key words: Anesthesia; Hand; Surgical procedures,operative; Wide-awake

Comparison to effect and safety of using tourniquet during different time interval of total kneearthroplasty

Objective To explore the effect and safety of using tourniquet to patients during differenttime interval of total knee arthroplasty. Methods A total of 80 cases of patients, who had total knee arthroplasty at our hospital from 2010 to 2012, were divided into the experimental group and the control group randomly, according to the computer random grouping method, 40 cases each. The patients in the experimental group were used the tourniquet method when the osteotomy began. The tourniquet was used to the control group during the whole operation process. Various intraoperative indexes were compared between groups ： hemoglobin content （ 1, 3 and 5 day postoperatively）, red blood cell count and postoperative complications. Results The operation time and lose of blood volume of patients in the experimental group were （136.7 ± 18.6） min and （167.8 ± 16.8 ） ml. The operation time and lose of blood volume of patients in the control group were （138.6 ± 19.4） min and （ 174.8 ± 14.6） ml. There were no significant differences between these two groups of patients （ t = 0. 447, 1. 989, respectively; P 〉 0.05 ）. The hemoglobin content of 1,3 and 5 days postoperatively of the experimental group were （7.6 ± 0.8 ）, （ 15.9 ± 1. 1 ） and （ 16.3 ~ 1.3 ） g/L, respectively. The hemoglobin content of 1, 3 and 5 days postoperatively of the control group were （7.9 ± 0.7 ）, （ 16.4 ± 1.2 ） and （ 16.8 ± 1.1 ） g/L, respectively. The comparison between groups were without statistical differences （ t = 1. 785, 1. 943, 1. 857, respectively; P 〉 0.05 ）. The red blood cell count of 1, 3 and 5 days postoperatively of the experimental group were （0. 18 20.02）, （1.23 20.22） and （1.58 ±0.39） ×1012/L, respectively. The red blood cell count of 1, 3 and 5 days postoperatively of the control group were （0. 19 ~ 0.03）, （ 1.34 ±0.28 ） and （ 1.74 ± 0.42） × 1012/L, respectively. The comparison between groups were without statistical differences （t = 1. 754, 1. 954, 1. 766, respectively; P 〉0.05）. The incidence of postoperative complication in the control group was 52.5%, among which 6 cases suffered deep vein thrombosis, 4 cases suffered phase II wound infection, 7 cases suffered knee joint cavity heamatoma and 4 cases suffered common peroneal nerve injury. The incidence of postoperative complication in the experimental group was 5.0% , among which 1 cases suffered deep vein thrombosis, and 1 ease suffered heamatoma of knee joint cavity. There was no significant difference （ X2 = 22. 029, P 〈 0.05 ）. Conclusions Application the tourniquet method to patients during different time interval of total knee arthroplasty can reduce patients＇ postoperative complications, and it makes great contribution to patients＇ postoperative recovery. Key words: j- Knee; Arthroplasty; Replacement; Tourniquet; Time interval

Effects of Adjuvant Dexketoprofen in Regional Intravenous Anesthesia

Background and objectives: In our study, it is aimed to investigate the effectiveness of the use of local anesthetics by the addition of adjuvant drugs to the patients who had hand surgery with regional intravenous anesthesia. In this context, contributions of non-steroidal anti-inflammatory agent to the local anesthetics as adjuvant medication during and after surgery for the patients and their positive and negative effects on the patients were evaluated. Methods: The Study was designed to cover backward date range of January 2010-August 2011 period of University Hospital Operating Room records of the hand surgery patients operated with regional intravenous anesthesia (RIVA) and those were evaluated. Total 44 patients’ records retrospectively evaluated. The patients treated with prilocaine were selected as control group (Group 1), the other 22 patients treated with prilocaine and Dexketoprofen were selected as the adjuvant drug added group for the RIVA process (Group 2). The sensory and motor block onset and end times of the patients, the surgical wound pain VAS values and also VAS scores that could be derived from tourniquet pain were examined. Results: We found the positive impact on the patients, in terms of pain, as statistically significant, by the use of non-steroidal anti-inflammatory drug as an adjuvant, during and after surgery, for the RIVA technique. In this study, the starting and ending times of sensory and motor block, surgical wound VAS scores, tourniquet VAS scores measurements were taken. The mean onset time of sensorial block of Group I was calculated as 9.4 min, whereas Group II, mean onset time of sensorial block was calculated 7.09 min. In Group 2, 40 Minutes after the tourniquet had a lower VAS scores. Conclusion: It is concluded that, in the first 24 hours in RIVA, intraoperative and postoperative analgesic requirement was reduced by Dexketoprofen.