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Optimizing Tourniquet Pressure in Upper Extremity Surgery.

Sammy Othman¹, Ashley L Pistorio², Stephen Lopez³

¹Department of Plastic Surgery, Drexel University College of Medicine, Philadelphia, PA.

The Journal of Hand Surgery Asian-Pacific Volume

|November 18, 2021

Summary

This summary is machine-generated.

Reduced tourniquet pressures in upper extremity surgery are safe and effective. This study found pressures below 200 mmHg maintained surgical field visibility, reducing complications associated with pneumatic tourniquets.

Keywords:

Hand Tourniquet Upper extremity Wrist

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Area of Science:

Orthopedic Surgery
Surgical Technology
Anesthesiology

Background:

Pneumatic tourniquets are vital for hemostasis in upper extremity (UE) surgery.
Elevated tourniquet pressures are linked to adverse effects.
Optimal pressure determination methods are still debated.

Purpose of the Study:

To demonstrate the feasibility of using reduced tourniquet pressures in UE operations.
To identify factors associated with achieving lower tourniquet pressures.
To evaluate the safety and efficacy of reduced tourniquet pressures.

Main Methods:

Prospective study conducted from 2016-2018 at two surgical centers.
Involved 226 upper extremity operations with gradually reduced cuff pressures.
Compared reduced pressures against standard limb occlusion pressure.

Main Results:

Successfully achieved reduced tourniquet pressures with a mean of 187 mmHg.
Mean tourniquet application time was 25 minutes.
Chronological surgical number and patient BMI were significantly associated with tourniquet pressure (p < 0.05).
Breakthrough bleeding occurred in 4.5% of cases, unrelated to pressure thresholds or patient factors (p > 0.05).

Conclusions:

Reduced tourniquet pressures effectively mitigate tourniquet-related complications.
Lower pressures maintained adequate surgical field visibility.
Adoption of tourniquet pressures below 200 mmHg is encouraged for most UE procedures.