Tourniquet hemostasis. A clinical study

A clinical study was undertaken to evaluate the pneumatic tourniquet setting required for adequate hemostasis in extremity surgery. After induction of anesthesia, the pneumatic tourniquet pressure at which the peripheral pulse disappeared was determined using a Doppler stethoscope. For upper-extremity procedures 50 mm Hg was added to this setting to allow for collateral circulation and blood pressure changes. An average pressure of 189.9 +/- 24.1 mm Hg was used for the upper-extremity group (44 patients), and an average of 231.0 +/- 26.5 mm Hg was used for the lower-extremity group (40 patients). Maximum pressures utilized were 255 mm Hg in the upper extremity and 305 mm Hg in the lower extremity. This simple, noninvasive technique uses tourniquet pressure settings well below those recommended in standard reference texts without sacrificing the adequacy of hemostasis to obtain a "bloodless field."