OBJECTIVETo evaluate the efficacy and safety of tourniquet in total knee arthroplasty.

METHODStudies on comparison between with and without tourniquet in total knee arthroplasty were identified from Medline, PubMed, EMASE, Cochrane Library, CBM, Highwire, CNKI, VIP, Articles Digital Periodicals.All the randomized controlled trials were included for meta-analysis with RevMan 4.2.2 software.

RESULTSNineteen studies involving 15 in foreign languages, 4 in Chinese were identified. There were 1159 cases of knee replacement patients. The results of meta-analysis indicated that there were statistical difference between two groups on intraoperative blood loss (P = 0.000), the number of deep venous thrombosis (P = 0.020), thigh pain (P = 0.000), knee hematoma (P = 0.030), wound infection (P = 0.040), skin ecchymosis area (P = 0.000), and the increasing rate of knee circumference of 3 days after the operation (P = 0.000), while there were no statistical differences with respect to the total blood loss (P = 0.100), the number of blood transfusions (P = 0.150), operation time (P = 0.120), length of hospital stay (P = 0.350), the number of pulmonary embolism (P = 0.310), and skin blisters (P = 0.170).

CONCLUSIONSThe tourniquet for total knee arthroplasty can reduce intraoperative blood loss, but can not reduce total blood loss and the number of blood transfusions transfusion, can not improve operative efficiency, can not shorten the hospitalization time and promote the knee joint functional recovery. Furthermore the tourniquet increases the probability of occurrence on deep vein thrombosis, wound infection, hematoma and ecchymosis knee, it also causes knee swelling and thigh pain. It suggests minimize to use tourniquet in total knee arthroplasty.

Arthroplasty, Replacement, Knee ; adverse effects ; methods ; Humans ; Safety ; Tourniquets ; adverse effects

OBJECTIVETo determine the value of the use of a pneumatic tourniquet in total knee arthroplasty.

METHODSSixty patients were prospectively randomized into 2 groups, one group underwent total knee replacement with a tourniquet (n = 30) and one without (n = 30). Operating time, blood loss, postoperative mean morphine requirement, swelling, ecchymosis, earlier straight-leg raising and postoperative knee flexion were measured in both groups.

RESULTSThere was no significant difference in the total blood loss between the 2 groups although the intraoperative blood loss was significantly greater in those without a tourniquet. The mean morphine requirement, postoperative swelling, scope of ecchymosis, earlier straight-leg raising and postoperative knee flexion in the patients that had surgery without a tourniquet were significantly better than those with a tourniquet.

CONCLUSIONKnee arthroplasty operation with the use of a tourniquet has only small benefits on the total blood loss, but hinder in patients' early postoperative rehabilitation exercises.

Aged ; Arthroplasty, Replacement, Knee ; Blood Loss, Surgical ; prevention & control ; Female ; Humans ; Male ; Prospective Studies ; Tourniquets ; adverse effects

OBJECTIVETo investigate the effect of Shenmai injection on vascular endothelial active facters nitric oxide (NO) and endothelin-1 (ET-1), and pulmonary gas exchange induced by tourniquet deflation in patients undergoing lower extremity surgery.

METHODTwenty-six patients scheduled for unilateral lower extremity surgery were randomly divided into 2 groups: control group (group C, n = 14) and Shenmai injection group (group SM, n = 12). All the patients agreed to a combined spinal-epidural anesthesia at the L2-L3 interspace and a radial artery catheter was placed for sampling. Patients in group SM were injected Shenmai injection 0.6 mL x kg(-1) and physiological saline 100 mL, while patients in group C were injected equal volume of normal saline instead 15 min before tourniquet inflation. Blood samples which were used for blood gas analysis and measurement of nitric oxide (NO) and endothelin-1 (ET-1) were taken before tourniquet inflation (T0, baseline) and 30 min (T1), 2 h (T2), 6 h (T3), 24 h (T4) after tourniquet deflation.

RESULTCompared with the baseline values at T0, in group C at T3 P(a) O2 and the levels of NO were significantly decreased, while P(A-a) DO2 and the levels of ET-1 at T3 were significantly increased (P < 0.05 or P < 0.01), in group SM, the levels of NO at T3 were significantly decreased (P < 0.05). Compared with group C, the changes of P(a)O2, P(A-a) DO2, NO and ET-1 were significantly mitigated in group SM.

CONCLUSIONThe concentrations of NO and ET-1 is connected with the pulmonary gas exchange impairment induced by tourniquet application. Shenmai injection can improve the pulmonary gas exchange based on rising the level of NO, reducing the level of ET-1.

Adult ; Drug Combinations ; Drugs, Chinese Herbal ; administration & dosage ; pharmacology ; Endothelin-1 ; blood ; metabolism ; Endothelium, Vascular ; drug effects ; metabolism ; physiopathology ; Female ; Humans ; Injections, Intravenous ; Male ; Middle Aged ; Nitric Oxide ; blood ; metabolism ; Pulmonary Gas Exchange ; drug effects ; Tourniquets ; adverse effects

The common causes of rhabdomyolysis include trauma, hypoxia, drugs, toxins, infections and hyperthermia. Operative insults, including direct trauma and ischemia, have the potential to cause the development of rhabdomyolysis. Pneumatic tourniquets used during arthroscopic knee surgery to prevent blood loss have led to many complications such as nerve paralysis and vascular injuries. Rhabdomyolysis can also be caused by prolonged pneumatic tourniquet application without a midapplication release, and also from an increased application pressure, but the actual incidence of this is low. In order to prevent rhabdomyolysis, the clinicians must be aware of such risks and follow strict guidelines for the application time, the midapplication release and also the inflation pressure. Vigorous hydration and postoperative patient surveillance are helpful to prevent rhabdomyolysis. We have recently experienced a case of rhabdomyolysis after the arthroscopic knee surgery, and the rhabdomyolysis could have been associated with the use of a pneumatic tourniquet.
Adult ; Anterior Cruciate Ligament/injuries/surgery ; *Arthroscopy/statistics & numerical data ; Humans ; Kidney Failure/etiology/radionuclide imaging/ultrasonography ; Knee Joint/*surgery ; Male ; Postoperative Complications/etiology/radionuclide imaging/ultrasonography ; Rhabdomyolysis/*etiology/radionuclide imaging/ultrasonography ; Tourniquets/*adverse effects

OBJECTIVETo evaluate the protective effects of sodium aescinate (SA) preconditioning on the tourniquet-induced ischemia-reperfusion (I/R) injury after limbs operation.

METHODSSeventy-five patients with grade I-II issued by American Society of Anesthesiology undergoing lower limb operation were randomly assigned to 3 groups: the control group, low-dose SA-treated group and high-dose SA-treated group; each group enrolled 25 patients. The patients were treated with 5 mg and 10 mg SA 30 min before tourniquet inflation in the two treatment groups separately, while the patients in the control group received normal saline. Venous blood samples were obtained before tourniquet was inflated (T0 baseline). And 5 (T1), 10 (T2), 20 (T3) min after tourniquet was released. The nitric oxide (NO), malondialdehyde (MDA) and superoxide dismutase (SOD) levels were determined by commercial kits. Meanwhile, arterial pressure (MAP) and heart rate (HR) were monitored from an automatic invigilator.

RESULTSIn the control group, MDA and NO levels were increased, and SOD and MAP were decreased significantly after tourniquet deflation compared to T0 baseline (P<0.05). After tourniquet deflation, MDA and NO levels in the two treated groups were significantly decreased; meanwhile, SOD levels and MAP were increased, and the variations of HR were more stable compared with the control group (all P<0.05). There was no significant difference in all of the above between the two treated groups (P>0.05).

CONCLUSIONThe protective effects of SA preconditioning on tourniquet-induced limb I/R injury might possibly contribute to the increasing of SOD levels, and MAP and the decreasing of MDA and NO levels.

Adult ; Dose-Response Relationship, Drug ; Female ; Hemodynamics ; drug effects ; Humans ; Ischemic Preconditioning ; Leg ; blood supply ; pathology ; Male ; Middle Aged ; Protective Agents ; adverse effects ; pharmacology ; therapeutic use ; Reperfusion Injury ; blood ; drug therapy ; physiopathology ; Sodium ; adverse effects ; pharmacology ; therapeutic use ; Tourniquets ; Vital Signs ; drug effects ; Young Adult

Aged ; Arthroplasty, Replacement, Knee ; adverse effects ; methods ; Case-Control Studies ; Female ; Follow-Up Studies ; Humans ; Incidence ; Intraoperative Care ; instrumentation ; methods ; Male ; Middle Aged ; Osteoarthritis, Knee ; surgery ; Postoperative Complications ; diagnosis ; epidemiology ; etiology ; prevention & control ; Recovery of Function ; Risk Assessment ; Singapore ; epidemiology ; Tourniquets ; adverse effects ; Treatment Outcome

OBJECTIVETo compare the effect between nebulized and intravenous administration of Shenmai Injection () on pulmonary gas exchange function of patients following tourniquet-induced lower limb ischemia-reperfusion.

METHODSThirty-eight patients scheduled for lower extremity surgery were randomized into three groups using the closed envelop method: Shenmai Injection was administered 30 min before tourniquet inflflation by nebulization [0.6 mL/kg in 10 mL normal saline (NS)] in the nebulization group or by intravenous drip (0.6 mL/kg dissolved in 250 mL of 10% glucose) in the intravenous drip group, and equal volume of NS was given intravenously in the NS group; 15 in each group. Arterial blood gases were analyzed, serum levels of malonaldehyde (MDA) and interleukine-6 (IL-6) and interleukine-8 (IL-8) were determined using the method of thiobarbituric acid reaction and enzyme-linked immuno sorbent assay respectively just before tourniquet inflflation (T0), and at 0.5 h (T1), 2 h (T2), 6 h (T3) after tourniquet deflflation.

RESULTSCompared with baselines at T0, MDA levels signifificantly increased at T2, T3 in the NS group and at T3 in the nebulization group, and IL-6 and IL-8 levels were signifificantly increased at T2, T3 in NS, the intravenous drip and the nebulization groups (P <0.05). Arterial pressure of oxygen (PaO) at T3 was decreased, while alveolararterial oxygen tension showed difference (PA-aDO) at T3 in the NS group; RI at T3 in both intravenous drip and the nebulization groups were enhanced (P <0.05). Compared with the NS group, MDA and IL-8 levels at T2, T3, IL-6 at T3 in the intravenous drip group, and IL-8 at T3 in the nebulization group were all remarkably increased (P <0.05). Additionally, MDA level at T3 in the nebulization group was higher than that in the intravenous drip group (P <0.05).

CONCLUSIONSIntravenous administration of Shenmai Injection provided a better protective effect than nebulization in mitigating pulmonary gas exchange dysfunction in patients following tourniquet-induced limb ischemia-reperfusion.

Adult ; Blood Gas Analysis ; Drug Administration Routes ; Drug Combinations ; Drugs, Chinese Herbal ; administration & dosage ; pharmacology ; therapeutic use ; Female ; Humans ; Injections ; Interleukin-6 ; blood ; Interleukin-8 ; blood ; Male ; Malondialdehyde ; blood ; Pulmonary Gas Exchange ; drug effects ; Reperfusion Injury ; blood ; drug therapy ; physiopathology ; Tourniquets ; adverse effects