Tourniquet
Indications
- Ensure accurate bloodless field
- Prevent systemic toxicity in isolated limb perfusion with cytotoxic drugs
- biers block (guanethidine block)
Contraindications
- Peripheral vascular disease
- Elderly (relative)
- Patients at risk of DVT when operating on lower limbs
Procedure
- Give agent / iv first - can take up to 5 minutes for systemic circulation
- Elevate limb, exsangiunate (with "exsanguinator" / esmarch bandage)
- Apply soft padding
- Apply tourniquet; inflate to >70-100mmHg systolic
- Note tourniquet time
- Warm anaesthestist prior to tourniquet release
Lower limb 90-120 minutes
Upper limb
Complications
- Tourniquet site
- Skin: friction burns / chemical burns if applied to skin
- Nerve: Compression leads to neuropraxia
- Distal to tourniquet
- Vascular: Ishaemia / thrombosis
- Muscular: reperfusion injury (1) free radials released into hypoxic tissues (2)
- Systemic
- Haemodynamic changes at time to inflation/deflation
- Tissue hypoxia / cell lysis - raised lactate/acidosis, hyperkalaemia
- Hypercoagulability
- PE
