Pneumatic Tourniquet in Pediatric Surgery - Is it not Time to Break the Pressure of Habits?

Chrystelle Sola1,2*, Mamadou Mour Traore1,3, Julien Pico1,2, Lucie Coruble1, Jérémie Castanié1, Marion Delpon4 and Christophe Dadure1,2

1Department of Anesthesia and Critical Care Medicine, Montpellier University, France
2Department of Anesthesia and Critical Care Medicine, Institute of Functional Genomics, France
3Department of Anesthesia and Critical Care Medicine, Cheikh Anta Diop University, Senegal
4Department of Pediatric Orthopedic Surgery, Montpellier University, France

^*Correspondance to: Chrystelle Sola 

 PDF  Full Text DOI: 10.25107/2474-1647.2692

Abstract

Purpose: Pneumatic tourniquet is commonly used in limb surgery including in pediatric population. Despite the potential benefits on operating condition, its use is not without risk and can lead to disastrous adverse effects. In daily practice, tourniquet cuff pressures are commonly set arbitrary at standard pressures, based on empirical formulas or surgeon's experience or habits. In children, anatomical and physiological characteristics are rarely taken into account. This preliminary study aimed to evaluate the impact of a low tourniquet cuff pressure setting on operative field quality and surgical satisfaction. Methods: All children less than 16 years of age scheduled for elective extremity surgery were consecutively included. The tourniquet cuff pressure was defined on the base of the child's baseline systolic blood pressure increased by 50 mmHg. At the same time, the surgeon, who remained blind on the tourniquet cuff pressure applied, was asked to indicate the desired cuff pressure according to the usual individual practice. At the end of procedure, operative field quality and surgical satisfaction were collected. The applied tourniquet pressure was compared with the cuff pressure desired by the surgeons. Results: Thirty-two children (10 ± 4.5 years, 39 ± 20 kg) were included. The mean cuff pressure desired by surgeons was 207 ± 37 mmHg. In comparison, tourniquet cuff pressure applied was 146 ± 11 mmHg (difference in means: ΔTP: 28% [CI 95% 26-33%], p<0.001). The mean surgical satisfaction score referring to the quality of the operative field and operative conditions was 9 ± 1 with an excellent or good surgeon satisfaction in 100% of cases. Conclusion: In children up to 16 years, adjustment of tourniquet cuff pressure 50 mmHg above the baseline systolic blood pressure has resulted in a reduction of almost 30% of the cuff pressure compared to current practice without compromising the quality of the operative field. These preliminary data suggest the possible use of low tourniquet cuff pressure in children and the need to promote guidelines on the best practices for safer use of pneumatic tourniquet in pediatric surgery.

Keywords

Pediatric anesthesia; Pediatric surgery; Tourniquet cuff pressure; Peri-operative medicine

Cite the article

Sola C, Mour Traore M, Pico J, Coruble L, Castanié J, Delpon M, et al. Pneumatic Tourniquet in Pediatric Surgery - Is it not Time to Break the Pressure of Habits?. Clin Surg. 2019; 4: 2692..