AST Guidelines for Best Practices for Safe Use of Pneumatic Tourniquets

5 good visualization of the surgical site, but it did not reduce the actual blood loss. They further reported it decreased operation time only when it was released after wound closure and dressing. Lastly, the tourniquet might be associated with an increase in thromboembolic events and wound complications. The researchers recommend that surgeons should carefully consider the effectiveness and safety of using a tourniquet during total knee arthroplasty and inflating the tourniquet only during cementing the prostheses in place or for a limited time might be options to consider. 18 8) A randomized study was conducted to evaluate the effects of tourniquet use during total knee arthroplasty on functional and clinical outcomes and knee range of motion (ROM). Seventy patients were divided in half – thirty-five with tourniquet, thirty- five without. Patients in the non-tourniquet group had a better outcome in all knee injury and osteoarthritis outcome scores (KOOS) and better early knee ROM from time of surgery to postoperative week eight. However, no differences were recorded at the six- and twelve-month patient follow-ups. Postoperative pain and analgesic use were less in the non-tourniquet group; intraoperative blood loss was greater but did not require postoperative transfusions. Surgical time and visibility of the surgical site were similar. The researchers concluded that performing a total knee arthroplasty without a tourniquet results in faster recovery with improved knee ROM and was also associated with reduced pain and analgesic use. 19 Guideline II CSTs should be well-informed of the systemic complications related to the use of a pneumatic tourniquet to be an effective team member in supporting the care of the patient. 1. Deep vein thrombosis (DVT), pulmonary embolism and peripheral artery disease (PAD) are concerns of the surgeon and anesthesia provider during tourniquet use. The time periods of when the limb is exsanguinated and after cuff deflation present the potential for hemodynamic instability in the patient. An important correlation was reported between the occurrence of emboli and the length of tourniquet inflation. 20 The surgical team should be aware that DVT leading to pulmonary embolism can be a consequence of the patient experiencing intraoperative hemodynamic fluctuations and be prepared to assist the surgeon and anesthesia provider with immediate treatment. 9,21,22 A. Aglietti et al. (2000) conducted a study of twenty patients who underwent total knee arthroplasty (TKA); they were separated into two groups of ten with and without a tourniquet. Blood samples were collected during the perioperative period that indicated a systemic increase in prothrombin, thrombin and antithrombin. 23 The authors concluded that the use of a