PATHOPHYSIOLOGY OF TOURNIQUET RELATED NEUROMUSCULAR INJURY
Sezgin SARBAN1, Tolgay ŞATANA2, U Erdem IŞIKAN1, O Şahap ATİK3
1Harran Üniversitesi Tıp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalı, Şanlıurfa
2Ankara Eğitim ve Araştırma Hastanesi, Ankara
3Gazi Üniversitesi Tıp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalı, Şanlıurfa
Keywords: Pneumatic tourniquet, ischemiareperfusion injury, tourniquet related complications.
Abstract
The tourniquet causes decreased blood flow in neuromuscular tissues beneath and distal to the cuff. A small amount of residual blood flow from intramedullary vessels is inadequate to maintain aerobic metabolism. It becomes a dangerous instrument when it is used improperly. Severe complications related to tourniquet such as massive pulmonary thromboembolism, femoral arteriel obstruction and sudden death are rare. Moderate to severe pain, increased tissue edema, paralysis, tendon rupture, hypertension, tachycardia and increased temperature during general anesthesia are the reported adverse effects of pneumatic tourniquets. It is possible to diminish these complications, by using wide-limb shaped cuffs and lower pressures in extremity surgery. In conclusion, proper tourniquet application, at clinically relevant cuff inflation pressures and durations, lowers neuromuscular injury. Extremity surgeons must weight the advantages of a bloodless field against the disadvantages of tourniquet-related neuromuscular injury. The aim of this study was to review the mechanism of the tourniquet related neuromuscular injury.