전신마취와 척추마취 하에 하지 수술시 구혈기에 의한 혈역학적 변화

최윤정,도현우,전재규,김진모 啓明大學校 醫科大學 1999 계명의대학술지 Vol.18 No.2

A tourniquet is commonly used to achieve a bloodless field in surgery of the extremities. However, tourniquet use occasionally has been associated with intranperative hypertension and with circulatory collapse after deflation. The purpose of this study is to define the hemodynamic changes in this setting using thoracic electrical bioimpedance (TEB) device. Twenty patients of ASA class I, scheduled for lower extremities surgery using a thigh tourniquet, were randomly divided into two groups. Group I underwent general anesthesia (including enflurane) and group Ⅱ underwent spinal anesthesia (0.5% bupivacaine 12.5 mg). The changes of blood pressure (BP), heart rate (HR), stroke index (SI), cardiac index (CI), systemic vascular resistance index (SVRI), and end-diastolic index(EDI) were measured (1) before induction, (2) just before inflation of tourniquet, (3) at the time of the maximal change of CI within 10 minutes after inflation of it, (4) just before deflation of tourniquet, and (5) at the time of the maximal change of CI within 10 minutes after deflation of it. During a tourniquet inflation, SI, CI and SVRI were markedly changed in group I , but not effectively changed in group H. During a tourniquet deflation, CI and SVRI were changed significantly in group I and only SVRI was decreased effectively in group Ⅱ (p<0.05). However, there were no significant changes in BP, HR, and EDI in both groups during a tourniquet inflation and deflation. In cases of the use of a thigh tourniquet for lower extremities surgery, the hemodynamic fluctuations of CI and SVRI are obviously less changed in the spinal than in the general anesthesia during the inflation and deflation of a tourniquet and prominent during 5-10 minutes just after inflation and deflation of a tourniquet. Accordingly, it is suggested that spinal anesthesia is preferred to general anesthesia for the use of a thigh tourniquet in patients scheduled for lower extremities surgery and close observation is required during 5-10 minutes just after inflation and deflation of a tourniquet.

지혈대 마비에 대한 임상적 고찰

전재용,안희창,한예식,이정윤 大韓成形外科學會 1993 Archives of Plastic Surgery Vol.20 No.1

As the society has been industrialized, the number if industrial accident has increased. The hand surgeries have increased as the result of hand injuries in case of handing machine, postburn scar contractures of the hand and congenital anomalies of hand. The tourniquets used in these operations are essential instruments. The cause of tourniquet paralyses are carelessness in using touriquets and disorder of tourniquet. The causes of tourniquet paralysis seem to be related to tourniquet pressure and inchemic time. We experienced 5 cases of tourniquet induced paralysis of arm after the use of tourniquet. We surveyed similar cases of other surgeons and presented the cause of this serious complication. As a result, we recommend for the prevention of tourniquet induced paralysis as follows. 1. Check the pressure gauze before the use of s tourniquet. 2. Removal of the tourniquet cuff after deflation 3. Removal of the soft bandage after removal of the cuff 4. Optimum pressure for obtaining the bloodless field Adult : 250/300㎜Hg(upper/Lower extremity) Child : 200/250㎜Hg(Upper/Lower extremity) 5. Recommendable tourniquet time is within 2 hours. 6. Tourniquet should be placed 10 ㎝ above the epicondyle in the upper extremity. 7. Tourniquet be released in case of dissection of major artery due to prevention of postoperation hematoma

Effects of Tourniquet Use on Quadriceps Function and Pain in Total Knee Arthroplasty

( David Liu Fracs ),( David Graham Mbbs ),( Kim Gillies M Hlth. Sc ),( R. Mark Gillies ) 대한슬관절학회 2014 대한슬관절학회지 Vol.26 No.4

purpose: A pneumatic tourniquet is commonly used in total knee arthroplasty (TKA) to improve surgical field visualisation but may result in quadriceps muscle ischaemia. We performed this study to analyse the effect of the tourniquet on recovery following TKA. materials and methods: A prospective randomised single-blinded trial was undertaken to examine the effect of the tourniquet on post-operative pain, swelling, blood loss, quadriceps function and outcome following TKA. Twenty patients with osteoarthritis of the knee were randomised to tourniquet or no tourniquet groups. Quadriceps function was assessed using surface electromyography (EMG) during active knee extension. results: The no tourniquet group had significantly less pain in the early post-operative period compared to the tourniquet group. There was no difference in Oxford knee score, range of motion, or thigh and knee swelling up to 12 months post-operatively. Quadriceps function, measured by surface EMG, was compromised for the first six months post-surgery by tourniquet use. The radiological cement mantle at the bone prosthesis interface at 12-month follow-up was not affected by the absence of a tourniquet. conclusions: We believe that it is safe and beneficial for our patients to routinely perform TKA without a tourniquet.

Comparison of bolus administration effects of lidocaine on preventing tourniquet-induced hypertension in patients undergoing general anesthesia: a randomized controlled trial

김지욱,Lee A Ran,Park Eun Sun,Yun Minsu,Ryu Sung Won,Kim Uk Gwan,강동희,Kim Ju Deok 대한마취통증의학회 2022 Anesthesia and pain medicine Vol.17 No.1

Background: This study assessed the effect of a single bolus administration of lidocaine on the prevention of tourniquet-induced hypertension (TIH) and compared the effect of lidocaine to that of ketamine in patients undergoing general anesthesia.Methods: This randomized, controlled, double-blind study included 75 patients who underwent lower limb surgery using a tourniquet. The patients were administered lidocaine (1.5 mg/kg, n = 25), ketamine (0.2 mg/kg, n = 25) or placebo (n = 25). The study drugs were administered intravenously 10 min before tourniquet inflation. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were measured before tourniquet inflation, after tourniquet inflation for 60 min at 10 min intervals, and immediately after tourniquet deflation. The incidence of TIH, defined as an increase of 30% or more in SBP or DBP during tourniquet inflation, was also recorded.Results: SBP, DBP, and HR increased significantly over time in the control group compared to those in the lidocaine and ketamine groups for 60 min after tourniquet inflation (P < 0.001, P < 0.001, and P = 0.007, respectively). The incidence of TIH was significantly lower in the lidocaine (n = 4, 16%) and ketamine (n = 3, 12%) group than in the control group (n = 14, 56%) (P = 0.001). Conclusion: Single-bolus lidocaine effectively attenuated blood pressure increase due to tourniquet inflation, with an effect comparable to that of bolus ketamine.

무릎 관절경 수술 시 Fentanyl 투여가 압박띠 사용에 따른 혈역학적 변화에 미치는 영향

이윤숙 ( Yoon Sook Lee ),김재환 ( Jae Hwan Kim ),차문호 ( Moon Ho Cha ),민두재 ( Doo Jae Min ),김운영 ( Woon Young Kim ),장문석 ( Moon Seok Chang ),박영철 ( Young Cheol Park ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.1

Background: The use of a tourniquet can produce pain and increase in blood pressure. It is known that fentanyl reduces central sensitization, however its effect on blood pressure increase due to tourniquet is unknown. So we investigated the effect of fentanyl on tourniquet-induced changes of mean arterial blood pressure (MBP), heart rate (HR), and cardiac index (CI). Methods: ASA physical status I and II, who were scheduled for knee arthroscopic surgery using a tourniquet, were assigned into control (n=30) and fentanyl group (n=30). Anesthesia was maintained with enflurane, N2O and O2. Fentanyl was injected 1.5 ug/kg at 10 min before inflation of the tourniquet in the fentanyl group. Changes of the MBP, HR, CI were measured before and 10, 20, 30, 40, 50, 60 min after inflation of the tourniquet. Results: There were no differences in the baseline values. MBP was increased at 40, 50, 60 min in the control group. At 60 min, MBP was lower in the fentanyl than the control group. HR was decreased at 10 min in the fentanyl group. CI was decreased in all groups after tourniquet inflation. At 60 min, CI was more decreased in the control than the fentanyl group. Conclusions: Fentanyl injection prior to tourniquet inflation can attenuate the tourniquet induced hemodynamic changes in the knee arthroscopic surgery patients. (Korean J Anesthesiol 2009;56:6~10)

임상연구 : 무릎 관절경 수술 시 Ketorolac 투여가 압박띠 사용에 따른 혈압 변화에 미치는 영향

김운영 ( Yoon Young Kim ),신연식 ( Youn Sik Shin ),민두재 ( Doo Jae Min ),이윤숙 ( Yoon Sook Lee ),김재환 ( Jae Hwan Kim ),박영철 ( Young Cheol Park ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.5

Background: The use of a tourniquet can produce pain and cause increased blood pressure. Ketorolac is known to have analgesic effects at the peripheral and central levels, however, its effect on the increased blood pressure due to a tourniquet is unknown. Therefore, the effects of ketorolac on the tourniquet-induced changes in the systolic, and diastolic blood pressures (SBP & DBP), as well as the heart rate (HR), were investigated. Methods: ASA physical status I and II patients, who were scheduled for knee arthroscopic surgery using a tourniquet, were assigned to control (n = 20), K30 (n = 20) and K60 groups (n = 20). Anesthesia was maintained with enflurane, N2O and O2. Either 30 or 60 mg ketorolac was injected 10 min prior to tourniquet inflation in both the K30 and K60 groups. The changes in the SBP, DBP and HR were measured before and 10, 20, 30, 40, 50, and 60 min after tourniquet inflation. Results: There were no differences in the baseline SBP, DBP, and HR values. The SBP was higher than the baseline value at 10, 20, 30, 40, 50, and 60 min in the control and at 30, 40, 50, and 60 min in the K30 groups, but only at 60 min in the K60 group. At 60 min, the SBP was lower in the K60 than the control group. The DBP was higher than the baseline value at 50, and 60 min in the control, but not in the ketorolac groups. Conclusions: A 60 mg ketorolac injection prior to tourniquet inflation can attenuate the tourniquet induced increase in blood pressure in knee arthroscopic surgery patients. (Korean J Anesthesiol 2007; 52: 511~5)

The Use of Arm Tourniquet in Unilateral Carpal Tunnel Release: Does It Actually Have Advantage on Surgical Time & Clinical Outcome ?

Pyeong Soo Kim,Woo-Keun Kwon,Joo Han Kim,Youn-Kwan Park,문홍주 대한말초신경학회 2016 The Nerve Vol.2 No.2

Objective To compare surgical time and operation preparing time, as well as clinical outcome of unilateral carpal tunnel release (CTR) between the groups which used tourniquet and those whom did not. Methods Of 53 cases of unilateral CTR under local anesthesia from 2011 to 2015, 35 were performed by using forearm tourniquets, while the other 18 were done without using tourniquets. The two groups were compared in terms of surgical time, total operating room(OR) time, preparing time and post-operative clinical outcomes by patients’ satisfaction with the service. Results The mean surgical time was slightly shorter in cases performed with forearm tourniquets (31.63±6.86 vs. 33.33±4.75 min, p>0.05), however did not show any statistical significance. The mean total OR time (53.20±9.26 vs. 51.22± 7.03 min, p>0.05) also did not show any statistically significant differences between groups. However, the mean preparing time for surgery was shorter in the no-tourniquet group with statistical significance (17.89±4.44 vs. 21.57±7.72 min, p=0.03). All 53 patients revealed excellent or good surgical outcome, and there were no difference between two groups. Conclusion The use of forearm tourniquet in unilateral CTR operation under local anesthesia did not influence the actual surgical time nor the clinical outcomes, however did significantly reduce the preparing time for surgery. Therefore, considering the additional time needed for preparation without advantage on the surgical time or clinical outcomes, the use of tourniquet for this specific procedure is not optimal but optional, and can be selected following the surgeons preference.

A Case of Rhabdomyolysis Associated with Use of a Pneumatic Tourniquet during Arthroscopic Knee Surgery

이용구,박웅,김상훈,정훈,윤상필,양동호,김형종 대한내과학회 2010 The Korean Journal of Internal Medicine Vol.25 No.1

The common causes of rhabdomyolysis include trauma, hypoxia, drugs, toxins, infections and hyperthermia. Operative insults, including direct trauma and ischemia, have the potential to cause the development of rhabdomyolysis. Pneumatic tourniquets used during arthroscopic knee surgery to prevent blood loss have led to many complications such as nerve paralysis and vascular injuries. Rhabdomyolysis can also be caused by prolonged pneumatic tourniquet application without a midapplication release, and also from an increased application pressure, but the actual incidence of this is low. In order to prevent rhabdomyolysis, the clinicians must be aware of such risks and follow strict guidelines for the application time, the midapplication release and also the inflation pressure. Vigorous hydration and postoperative patient surveillance are helpful to prevent rhabdomyolysis. We have recently experienced a case of rhabdomyolysis after the arthroscopic knee surgery, and the rhabdomyolysis could have been associated with the use of a pneumatic tourniquet. (Korean J Intern Med 2010;25:105-109) The common causes of rhabdomyolysis include trauma, hypoxia, drugs, toxins, infections and hyperthermia. Operative insults, including direct trauma and ischemia, have the potential to cause the development of rhabdomyolysis. Pneumatic tourniquets used during arthroscopic knee surgery to prevent blood loss have led to many complications such as nerve paralysis and vascular injuries. Rhabdomyolysis can also be caused by prolonged pneumatic tourniquet application without a midapplication release, and also from an increased application pressure, but the actual incidence of this is low. In order to prevent rhabdomyolysis, the clinicians must be aware of such risks and follow strict guidelines for the application time, the midapplication release and also the inflation pressure. Vigorous hydration and postoperative patient surveillance are helpful to prevent rhabdomyolysis. We have recently experienced a case of rhabdomyolysis after the arthroscopic knee surgery, and the rhabdomyolysis could have been associated with the use of a pneumatic tourniquet. (Korean J Intern Med 2010;25:105-109)

Intraoperative tourniquet-induced hyperthermia in a pediatric patient: a forgotten association -a case report-

Tageldin Tarek,Khan Muhammad Jaffar,Baykuziyev Temur,Ahmed Haitham 대한마취통증의학회 2024 Korean Journal of Anesthesiology Vol.77 No.3

Background: The intraoperative use of tourniquets is associated with several complications, including hyperthermia. We present the first documented case of tourniquet-induced hyperthermia in a pediatric patient at our institution.Case: A 5-year-old female with no past medical history underwent tendon release surgery for congenital talipes equinovarus under general anesthesia. Following inflation of a pneumatic tourniquet to a pressure of 250 mmHg on her left thigh, the patient experienced a gradual increase in body temperature. Despite the implementation of cooling measures, the temperature continued to increase until it plateaued. The hyperthermia gradually resolved upon deflation of the tourniquet. Conclusions: Tourniquet-induced hyperthermia should be considered as a potential cause of intraoperative hyperthermia, particularly in the absence of typical signs of malignant hyperthermia. Early recognition and appropriate management, including deflation of the tourniquet and implementation of cooling measures, are crucial for preventing potential complications associated with hyperthermia.

고무 도뇨관을 이용한 간단한 수지 지혈대

김상화,임영민,정성노,권호 대한성형외과학회 2008 Archives of Plastic Surgery Vol.35 No.6

Purpose: Surgery on digit requires a clear, bloodless field and it can be achieved by using a tourniquet. Several type of tourniquet have been used including Penrose drains and sterile glove with hemostat. We present a simple digital tourniquet using nelaton catheter, which is easily available, inexpensive, easy-to-apply, and effective for digital surgery. Methods: We made a small incision on the opposite side of an opening at the tip of nelaton catheter. Then the other tip of nelaton catheter is passed through the incision to form a ring. Nelaton catheter is placed aournd the base of the injured finger, making a tight circle to desired pressure. Results: A simple tourniquet using nelaton catheter effectively achieves a bloodless field and allows fine control of the pressure for digital surgery. Conclusion: We present a sismple digital tourniquet using nelaton catheter, which is easily available, inexpensive, tunable, and available for more than one finger.