Disease relevance of Tourniquets

• A phase II study of the efficacy of diamminedichloroplatinum (cisplatin) for the control of locally recurrent and intransit malignant melanoma of the extremities using tourniquet outflow-occlusion techniques [1].
• Muscular ischemia of different duration was induced by use of a tourniquet applied to the rear left leg of rabbits under normothermic or hypothermic conditions, and variations in serum creatine kinase, lactate dehydrogenase, K+, Ca2+, and lactate were determined at various intervals after blood flow was restored [2].
• Renal vein renin sampling in essential hypertension using hydralazine and the tourniquet test [3].
• Acute bupivacaine toxicity as a result of venous leakage under the tourniquet cuff during a Bier block [4].
• Ketorolac administered before tourniquet inflation prevents postoperative pain being perceived as more intense than preoperative pain [5].

High impact information on Tourniquets

• Enhanced in-vivo platelet release reaction, increased thromboxane synthesis, and decreased prostacyclin release after tourniquet ischaemia [6].
• The mean plasma beta-TG and TxB2 had risen significantly within 5 min of release of the tourniquet, indicating increased in-vivo platelet release reaction and prostaglandin synthesis in these patients [6].
• Ten minutes after the release of the tourniquets, plasma leukotriene B4 levels increased to 395 +/- 85 pg/ml, higher than 129 +/- 35 pg/ml in controls (n = 9, p less than 0.01) [7].
• Decomplementation with cobra venom factor (n = 4) resulted in plasma C3 levels, 10% of baseline, but tourniquet release still led to pulmonary hypertension, elevated LTB4, TxB2 levels, and a decline in WBC count similar to that of untreated ischemic control animals [8].
• After total outflow occlusion with pneumatic tourniquet, the cell-cycle nonspecific anti-neoplastic agent cis-diamminedicholoroplatinum (CDDP) was infused intra-arterially in a mean dose of 26.7 mg/m2 per infusion (2.6 infusions per patient) [1].

Chemical compound and disease context of Tourniquets

• All volunteers (five of five) given lidocaine and one volunteer given high-dose ropivacaine reported light-headedness and hearing disturbance during tourniquet release when the arterial plasma lidocaine and ropivacaine concentrations were 4.7+/-2.1 microg/ml (mean) and 2.7 micro/ml, respectively [9].
• Respiratory depression was monitored by ventilatory and occlusion pressure responses during CO2 rebreathing, while analgesia to experimental pain was identified with the submaximal effort tourniquet ischemia test [10].
• Thirteen New Zealand white rabbits were subjected to 10 min of global cerebral ischemia produced by neck tourniquet inflation (20 psi) combined with systemic hypotension during halothane (1-1.5%) anesthesia [11].
• Phenylephrine-induced hypertension caused an opposite effect on the CFR of rostral ventromedial medulla neurons as compared with a noxious stimulus such as heat or maintenance of tourniquet inflation [12].
• Venous irritation and/or urticaria after tourniquet release was observed on 10 occasions in those receiving 2-chloroprocaine and twice in those receiving prilocaine [13].

Biological context of Tourniquets

• Changes in venous blood lactate, venous blood gases, and somatosensory evoked potentials after tourniquet application [14].
• Anesthesiologists perform a median of four upper-limb IVR procedures per month, most often using 50 mL of lidocaine 0.5% at tourniquet pressures of 250 mm Hg or 100 mm Hg greater than the systolic blood pressure [15].
• Four volunteers in the chloroprocaine group had increased in heart rate (greater than 20%) and one of them short periods of junctional rhythm during the first 2 min after tourniquet deflation [16].
• Pharmacokinetics of moxisylyte in healthy volunteers after intravenous infusion and intracavernous administration with and without a penile tourniquet [17].
• We conclude that ketamine sedation attenuates lipid peroxidation markers in arthroscopic knee surgery with tourniquet application [18].

Anatomical context of Tourniquets

• Hydralazine and the tourniquet test in renal vein renin sampling: a comparison [19].
• After release of the tourniquet, return of sensation to TES, pinprick (ulnar nerve), and return of motor function occurred later with levobupivacaine at median 25, 15, and 21.25 versus 10, 4.5, and 10 min with lidocaine [20].
• After release of the tourniquet, the first evidence for return of sensation in the distribution of the five peripheral nerves occurred later in the ropivacaine group (median, 20 min; range, 15-40 min) than in the lidocaine group (median, 1 min; range, 1-25 min) [21].
• Creatine phosphokinase release as a measure of tourniquet effect on skeletal muscle [22].
• The incidence of tourniquet pain was evaluated in 40 patients having orthopedic surgery of the lower extremities during spinal anesthesia using 15 mg of a plain solution of either 0.5% tetracaine or 0.5% bupivacaine [23].

Associations of Tourniquets with chemical compounds

• After the release of the tourniquet there was a rapid restoration of the phosphagen content and clearance of lactate in the ischemic leg [24].
• In untreated animals (n = 7), tourniquet release led after 5 minutes to a rise in plasma thromboxane (Tx) B2 levels from 360 to 1702 pg/ml (p less than 0.05); after 2 hours, lymph TxB2 concentration had risen from 412 to 1598 pg/ml (p less than 0.05) [25].
• Prior to tourniquet inflation, both OKY 046 and ketoconazole lowered plasma TxB2 levels as well as the L/P ratio (p less than 0.05) [26].
• Self-monitoring of blood glucose: tourniquet method [27].
• Adrenal weight and plasma corticosterone after tourniquet or ether stress were indistinguishable in the AH and H groups and were much higher and nearly identical in the intact, NH and IAH groups [28].

Gene context of Tourniquets

• RESULTS: Only when a tourniquet was applied for a mean time of 105 minutes did elective limb surgery result in significantly increased serum levels of IL-6, IL,-1ra, and IL-10 but not TNF-RII [29].
• Tourniquet tests were performed in 2 patients, with no appreciable rise in PAI-1 activity or PAI-1 antigen levels [30].
• Induction of interleukin-6 and upregulation of glycoprotein 130 mRNA expressions were observed in the ipsilateral dorsal root ganglion at 4 h after tourniquet application [31].
• Two groups of 12 rats were given either intravenous superoxide dismutase and catalase or dimethylthiourea 30 min before tourniquet release, continuing throughout the period of reperfusion [32].
• Treatment groups received either equal volumes of normal saline or activated protein C prior to tourniquet release [33].

Analytical, diagnostic and therapeutic context of Tourniquets

• BACKGROUND: Ketorolac, when added to lidocaine, has been shown to reduce early tourniquet pain during intravenous regional anesthesia (i.v.RA) in patients [34].
• Carbon dioxide was insufflated at a pressure of 30 mm Hg into the subfascial space to facilitate dissection, and a pneumatic thigh tourniquet was used to obtain a bloodless operating field [35].
• Decreased incidence of tourniquet pain during spinal anesthesia with bupivacaine. A possible explanation [36].
• IMPLICATIONS: Preoperative small-dose ketamine, IV, significantly prevented a systemic arterial pressure increase during prolonged tourniquet inflation in patients under general anesthesia [37].
• Endothelin-1 is secreted after total knee arthroplasty regardless of the use of a tourniquet [38].

References