The Tourniquet in Surgery A Review

Abstract

The tourniquet can be a valuable tool during surgery on extremities. However, its use is not without clanger. Tourniquet ischemia causes profound changes in tissue and venous pH, PO2, and PCO2 concentrations. An increased bleeding tendency has been noted in dogs after 4 hours of tourniquet ischemia. Muscular damage and nerve palsies are also important complicating factors. The inflation pressure should be the minimum that provides a bloodless field, and pressures greater than 300 mm Hg should be avoided. Duration of use should be minimized, and probably should not exceed 3 hours. A pneumatic tourniquet should be used. An Esmarch bandage should be used only to expel venous blood from the limb and not as a tourniquet device. The inflation and deflation time should be recorded. Previous planning of the operation will allow the surgeon to maximize usefulness of the ischemic period. The surgeon must ensure that the tourniquet has been removed after an operation.