AST Guidelines for Best Practices for Safe Use of Pneumatic Tourniquets

17 e) Pediatric patients – add 50 mm Hg. 11 f) Frequently monitor the pressure, particularly when the surgeon must reposition the limb. 50 The pressure setting is affected by repositioning the extremity during a procedure. 6 Pressure setting is also affected by changes in the patient’s systolic pressure and by cuff width in relation to limb circumference. 6 g) The LOP is determined during the patient preoperative appointment or when the blood pressure is stabilized after anesthesia induction. 11 h) Odinsson et al. (2006) reported that forty-one percent of the 265 surgeons who responded to a survey reported that a lower tourniquet pressure should be used for pediatric patients and forty surgeons reported that the cuff pressure should be reduced with the use of a wider cuff. 5 i) Clarke et al. (2001) studied thirty-one patients undergoing total knee arthroplasty to determine if the use of a tourniquet had any influence on postoperative wound hypoxia. The patients were divided into three groups of ten – one group had no tourniquet; second group had a tourniquet applied at 125 mm Hg above mean arterial blood blood pressure and the third group at 250 mm Hg also above mean arterial blood pressure. The authors concluded that the use of a high-pressure tourniquet increases the postoperative wound hypoxia and recommended that the lowest possible cuff pressure should be used to decrease complications. 79 C. Other methods for determining minimum cuff inflation pressure include either by pulse oximetry or by using an ultrasonic blood-flow detector (Doppler stethoscope) to confirm the absence of the arterial pulse. 6,11,50 D. The guidelines for tourniquet pressure for the adult are: 1) The pressure should never exceed 500 mm Hg. 50 2) Fifty mm Hg above the patient’s systolic blood pressure for upper extremities. 64 3) 100 mm Hg above the patient’s systolic blood pressure for lower extremities. 64 4) Frequently monitor the pressure, particularly when the surgeon must reposition the limb. 50 The pressure setting is affected by repositioning the extremity during a procedure. 6 Pressure setting is also affected by changes in the patient’s systolic pressure and by cuff width in relation to limb circumference. 6 5) Odinsson et al. (2006) reported that forty-one percent of the 265 surgeons who responded to a survey reported that a lower tourniquet pressure should be used for children and forty surgeons reported that the cuff pressure should be reduced with the use of a wider cuff. 5