Surgical Tourniquets

Abstract

Tourniquets are used in extremity surgery to minimize bleeding, improve surgical field visualization, and confine anesthetic to an extremity (e.g., during a Bier block). In scenarios of trauma, tourniquets can save lives by halting a patient’s imminent exsanguination and getting the patient safely to a hospital for treatment and resuscitation. However, they also carry risks that all surgeons need to be aware of. Perhaps for this reason, many institutions have protocols in place to safeguard patients from tourniquet-related complications.

Tourniquets come in multiple forms. Any compressive device that surrounds an extremity can function as a tourniquet, from an Esmarch bandage to the more commonly used pneumatic devices. Originally invented in the 1980s, the pneumatic tourniquet consists of an inflatable cuff, a compressed gas source, and a pressure regulator that maintains the desired cuff pressure. Typically, the cuff pressure is visible on a monitor, which also keeps close track of the tourniquet time, which also corresponds to ischemic time for the involved extremity. Most modern tourniquets will alarm if there is a cuff leak or if the tourniquet time is reaching certain milestones. These tourniquets can be either disposable or reusable.