Tourniquet Theory

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DISCUSSION
The use of a pneumatic tourniquet may be associated with local complications including limb paralysis, nerve, muscle, vessel, skin damages and other injuries such as compartment syndrome (1-3). Clinical and experimental studies showed that nerve conduction abnormalities and muscle dysfunctions occur after 30-45 minutes of tourniquet application in more than 70 % of lower extremity surgeries which persisted up to 6 months and correlated with impaired postoperative function and delayed recovery after tourniquet use. Moreover, it has been suggested that incidence of these abnormalities may be underreported (4).These abnormalities have been attributed to length of ischemia period as well as excessive inflation pressures used. As a goal,
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In our previous studies, we used a controlled hypotension and minimal inflation pressure (CHAMIP) technique which provided a bloodless field in almost all patients with a mean tourniquet pressure of 169.7±7.9 mmHg and 118.2±7.2 mmHg significantly lower inflation pressures than reported and recommended in the literature in lower and upper extremity surgeries respectively (25, 26). Those studies showed that the anesthetic management is of critical importance in order to prevent intraoperative hemodynamic fluctuations and use minimal inflation pressures at all-time points of the surgery. In our study, the surgical team was satisfied with the performance of the tourniquet in 97.75 % cases using mean initial and maximal tourniquet pressures utilized of 168.4±14.5 and 173.3±15.6 mmHg respectively. One of the main factors that allowed lower inflation pressures in our study was the use of AOP estimation method which provided quick and accurate results. The other factor was a safety margin of 20 mmHg we used which is lower than recommended in the literature. The last factor was the anesthetic management which allowed hemodynamic stability. Regional anesthesia techniques (spinal, combined spinal epidural anesthesia) and general anesthesia was used in 92.8 % and 7.2 % of cases respectively and maximal SBP of the patients were only 4.8 % higher compared with initial SBP values (103.5 ± 10.4 versus 98.7 ± 9.6) throughout the tourniquet period. In three patients, the surgical team rated the surgical field as fair at start of the operation. Two of those patients were rated as fair and one of them was rated as excellent in the middle of the operation. The surgeon was pointed out that the amount of blood did not adversely affect these surgical procedures or their duration. Since the amount of blood in the surgical

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