Anesthesia for Orthopedic Surgery

Tourniquets

o Virtually bloodless field highly desirable

o Width should cover 50% of target extremity
o Padding such as stockinette
o Avoid wrinkles in padding
o Overlap of cuff should be opposite of
neurovascular bundle
o Inflation pressure usually 100mmHg greater than
systolic blood pressure

Tourniquets

Inflation pressures

 Should not exceed 300mmHg in upper

extremities
 Should not exceed 500 mmHg in lower
extremities

Exsanguination important before inflation

 Elevation or Esmarch bandage

1
 Tourniquet pain

 Compression of Intraneural blood vessels

 Causes secondary nerve ischemia

 Leads to stimulation of pain pathways

 Onset 45-60 minutes after inflation

 Similar to thrombotic vessel occlusion

 Activation of C fibers – burning and aching

 Activation of A delta fibers – pins and needles

 Treatment options

Tourniquet Safety

o Always place where nerves are best protected in

the musculature

o Check proper function of machine

o Never inflate for longer than 2 hours

o Minimally effective pressure to occlude blood flow

o Put display where you can see it

o Report 60 minutes, then 15 min increments after

that to the surgeon and be sure to chart that you
did

o Always chart times on your record