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Tourniquets (Minimisation of complications (CI to tourniquet use (AV…

- - - - 20% greater than diameter of arm (enables lower inflation pressure for arterial occlusion (Force = inflation pressure x area beneath cuff)
  - - - Short duration (max 2hrs)
      - Breaks for reperfusion if req after this time (10mins)
    - - Should have a relationship to the SBP (e.g. 50-100mmHg greater) to reduce anterograde flow
      - Maximal pressures are controversial
      - Normally 200mmHg is adequate for the UL and 250mmHg for LL (increase if atherosclerosis or morbid obesity)
  - - - Resistant to anaesthesia and analgesia
      - Only effective method is temp tourniquet release
- - - - Embolisation risk (DVT, septic or tumour material)
      - Increased central volume and increased SVR (increased BP and CVP)
    - - Tourniquet failure intra op
      - Bleeding if anterograde flow is not reduced and VR is obstructed
      - Tourniquet pain from one hour after inflation (increased HR and BP) - mediated by C fibres
    - - Blood volume shifts and release of anaerobic metabolites (lactate, K+) and CO2 causes metabolic and haemodynamic changes - myocard depression, reduced SVR and MAP, reduced CVP.
      - Bleeding
      - Embolisation risk (air, fat, cement)
  - - - Poor application technique
      - Mechanical pressure (nerve), ischaemia (muscle)
    - - Poor application technique
      - Moisture under padding
    - - Post tourniquet syndrome (oedematous, pale, stiff limb with weakness but no paralysis)