Tourniquet complications in an upper extremity orthopedic surgery patients

Abstract

An arterial tourniquet is a pneumatic device consisting of an inflated cuff connected to a supply of compressed gas. The most common use for these tourniquets is in surgical procedures on the extremities, where the tourniquet is very useful in optimizing the operating conditions by creating a bloodless surgical field. However, the exsanguination process followed by ischemia will result in physiological problems with local and systemic consequences. The patient in the case to be discussed is a 54-year-old woman with a diagnosis of implant loosening et causa nonunion left Montegia fracture who was scheduled for implant revision surgery. From these cases, it is possible that the patient experienced tourniquet-induced hypertension, which is one of the systemic complications that can arise due to the use of the tourniquet. It is said that tourniquet-induced hypertension is often difficult to control and is resistant so it is difficult to lower it. Emerging hypertension may not present a significant problem in young, noncomorbid patients, but in these patients with comorbid of hypertensive heart disease (HHD), elevated blood pressure can be very detrimental. Preoperative ketamine, clonidine, or lidocaine has been used to prevent tourniquet pain, which can lead to increased arterial pressure that is difficult to control. The anesthetist is also obliged to monitor the duration and pressure applied by the tourniquet so that it is not excessive so that detrimental complications can be prevented.