The tourniquet in total knee arthroplasty. A prospective, randomised study.
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We assessed the influence of the use of a tourniquet in total knee arthroplasty in a prospective, randomised study. After satisfying exclusion criteria, we divided 77 patients into two groups, one to undergo surgery with a tourniquet and one without. Both groups were well matched. The mean change in knee flexion in the group that had surgery without a tourniquet was significantly better at one week (p = 0.03) than in the other group, but movement was similar at six weeks and at four months. There was no significant difference in the surgical time, postoperative pain, need for analgesia, the volume collected in the drains, postoperative swelling, and the incidence of wound complications or of deep-venous thrombosis. We conclude that the use of a tourniquet is safe and that current practice can be continued. (+info)
The effect of using a tourniquet on the intensity of postoperative pain in forearm fractures. A randomized study in 32 surgically treated patients.
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We have analysed the relationship between the intensity of postoperative pain and the use of a pneumatic tourniquet in procedures for operative fixation of fractures of the forearm. Thirty-two patients were divided randomly into two groups as a control (NT) and tourniquet (T). The pain scores in the NT group were significantly lower. Patients over the age of 30 had notably more pain than those younger after the use of a tourniquet. Avoidance of the tourniquet gave better postoperative analgesia in male patients and in those with comminuted fractures. When a tourniquet was used the best results were obtained if it was kept inflated for less than one hour. (+info)
Simultaneous bilateral total knee arthroplasty in a single procedure.
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Eighty-eight consecutive patients undergoing total knee arthroplasty (TKA) were reviewed retrospectively and divided into two groups. Group I (64 patients) had both knees replaced simultaneously by one team in a single procedure while Group II (24 patients) had 2 operations staged about 7 days apart. The blood loss, operative time, knee functional score, period of hospitalisation and complications were documented in order to compare the 2 groups. Performing simultaneous bilateral TKA (Group I) did not increase the incidence of operative or post-operative complications. Equally, the functional score and mean intra- and post-operative blood loss were not influenced. The operative time and duration of hospitalisation were significantly shorter in Group I than in Group II. On the basis of the results of this study, it appears that simultaneous bilateral TKA is beneficial. (+info)
Duplex scanning may be used selectively in patients with primary varicose veins.
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Reflux was assessed using hand-held Doppler (HHD) and duplex scanning in 72 patients with primary, previously untreated varicose veins (108 limbs). The aims of the study were (i) to compare the accuracy of HHD assessment with duplex scanning, (ii) to assess the benefit of tourniquet testing and (iii) to identify patients who would benefit from a policy of selective duplex scanning. HHD accurately assesses the saphenofemoral junction (SFJ) and long saphenous vein (LSV) reflux. HHD assessment of the saphenopopliteal junction (SPJ) reflux has a low positive predictive value. A high negative predictive value reflects absent SPJ reflux assessed using HHD accurately. Tourniquet testing is not helpful. Selective duplex scanning of limbs with suspected SPJ reflux, no identifiable site of reflux or posterior thigh perforator reflux on HDD (39% of limbs), would result in the appropriate surgical procedure being performed in 102 (94%) limbs, excessive surgery in 5 (5%) limbs and inadequate surgery in only 1 (1%) limb. The use of selective criteria for duplex scanning would reduce the workload of the vascular laboratory without compromising patient care. (+info)
Intraoperative spasm of coronary and peripheral artery--a case occurring after tourniquet deflation during sevoflurane anesthesia.
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A 68-yr-old man with a 9-yr history of hypertension presented for hemiglossectomy, segmental resection of the mandible, and the radial forearm free flap grafting. Intraoperatively, facial artery spasm was observed during microvascular suturing of the radial artery to the facial artery. Simultaneously, systolic blood pressure decreased from 100 to 80 torr and the ST segment elevated to 15 mm from the base line. The possible mechanisms responsible for vasospasm in coronary as well as in peripheral arteries under sevoflurane anesthesia are discussed. (+info)
Traditional bone setter's gangrene.
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Traditional bone setter's gangrene (TBSG) is the term we use to describe the sequelae sometimes seen after treatment with native fracture splints. Twenty five consecutive complications were recorded in 25 patients aged between 5-50 years with a median age of 10 years. The major complication of the native fracture splint treatment was distal limb gangrene necessitating proximal amputations in 15 cases. (+info)
Analgesic effect of adenosine on ischaemic pain in human volunteers.
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This study was designed to measure ischaemic pain during and after infusion of adenosine. In a double-blind, placebo-controlled, crossover study, eight ASA 1 male volunteers received infusion of adenosine 100 micrograms kg-1 min-1 or placebo for 10 min. This was repeated 1 week later with the alternate infusion. Pain measurements were made during tourniquet-induced ischaemia in an exercising arm before infusion, during infusion and for 24 h afterwards. Pain was reduced significantly in the adenosine group compared with the saline group during infusion (median difference 20.8; 95% confidence interval 2.0-40). There was no significant difference in pain after infusion and there were no significant changes in cardiovascular variables. During infusion of adenosine, transient mild chest discomfort, shortness of breath and facial flushing occurred. We conclude that adenosine had measurable effects on ischaemic pain which were not sustained after discontinuation of infusion. (+info)
Endothelial cell compatibility of clindamycin, gentamicin, ceftriaxone and teicoplanin in Bier's arterial arrest.
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In patients with infected diabetic foot lesions, and gangrenous, peripheral, occlusive arterial disease, it is important to achieve high concentrations of antibiotics in the tissues, as the extent of amputation is often influenced by the presence of infection. Local transvenous pressure injection of antibiotics, in Bier's arterial arrest, allows high local tissue concentrations to be attained in the extremities. Information on the endothelial compatibility of antibiotics in high concentrations combined with the effect of reperfusion injury following tissue hypoxia is lacking. To evaluate the effect of clindamycin, gentamicin, ceftriaxone and teicoplanin injected in Bier's arterial arrest, on endothelial cells, an in-vitro model using human umbilical venous endothelial cells (HUVEC) has been devised. The intracellular levels of purine nucleotides, reflecting DNA/RNA synthesis, energy production and signal transduction of these cells were measured by means of high-performance liquid chromatography. Incubation of cells with 10 mg/mL clindamycin, gentamicin, ceftriaxone and teicoplanin for 20 min resulted in no significant decline of intracellular purines. Levels of purines obtained after exposure of the cells to 0.1 mmol/L hydrogen peroxide (H2O2), to simulate reperfusion injury, were not significantly different from those obtained from cells allowed to recover after antibiotic exposure. These findings indicate that the infusion of high doses of antibiotics, during Bier's arterial arrest, is compatible with maintenance of endothelial cell function, even in the presence of increased free radical activity, provided the exposure is limited to 20 min. (+info)