AST Guidelines for Best Practices for Safe Use of Pneumatic Tourniquets

21 reported no complications occurred during the procedures and no patients required blood transfusion. The reported mean total blood loss for all the procedures was 819 mL. 93 Total blood loss in the group with cuff release before wound closure was 906 mL and in the group with cuff release after wound closure 731 mL. 93 The authors concluded that the cuff should be deflated after wound closure during total knee arthroplasties and to apply a pressure dressing that reduces the blood loss. 93 3) Thorey et al. (2008) conducted a randomized prospective study involving twenty patients who underwent simultaneous bilateral total knee arthroplasty. Technique A involved operating on one knee with cuff deflation and hemostasis before wound closure and Technique B on the other knee involved cuff deflation after wound closure and application of the pressure dressing. The results showed no significant difference in blood loss between the two techniques as well as no increase in postoperative complications. 94 However, there was a significant difference in operating time with Technique B having a shorter length to time. 94 The authors recommended tourniquet release after wound closure to reduce operating time and risks of extended anesthesia. 94 D. There may be instances of when the surgeon requests the tourniquet to be deflated intraoperatively. Marson and Tokish (1999) studied whether an inflated tourniquet affected the intraoperative patellofemoral tracking during total knee arthroplasty. The authors concluded that use of an inflated tourniquet could alter intraoperative patellofemoral tracking and the tourniquet should be deflated to contribute to accurate tracking before proceeding with the lateral release step of the procedure. 95 Guideline IV The CST should be knowledgeable of the safety precautions that are unique to the use of IVRA, also referred to as a Bier block. 1. During the preoperative assessment of the patient, allergies to local anesthetics should be confirmed which can determine if IVRA will be utilized. 51 2. When the anesthesia provider is employing IVRA, the CST should assist in confirming the immediate availability of the drugs that are required for treating adverse systemic reactions to the local anesthesia in the event of tourniquet failure and be prepared to assist the anesthesia provider. 50 A. Accidental introduction of the local anesthetic into the patient’s systemic circulation can quickly affect the central nervous and cardiac systems. If the patient is sedated but awake symptoms he/she may communicate to the surgical team include dizziness, drowsiness, and tinnitus. However, if the patient is under general anesthesia signs and symptoms that the anesthesia provider will recognize include bradycardia and respiratory depression. 78 B. The primary cause of for adverse reactions occurring is technical error. 78 The following are instances that may result in the patient experiencing a