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Venous pressure during intravenous regional anesthesia: Implications for setting tourniquet pressure

BACKGROUND AND AIMS: Intravenous regional anesthesia (IVRA) is utilized for upper extremity surgery, but higher tourniquet pressure and longer inflation time increase the risk of soft tissue and nerve injury. We investigated the duration and magnitude of elevated venous pressure during IVRA to asses...

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Autores principales: Farhang, Borzoo, Lesiak, Alex C., Ianno, Daniel J., Minasyan, Hayk, Shafritz, Adam B., Viscomi, Christopher M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6360886/
https://www.ncbi.nlm.nih.gov/pubmed/30774232
http://dx.doi.org/10.4103/joacp.JOACP_69_16
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author Farhang, Borzoo
Lesiak, Alex C.
Ianno, Daniel J.
Minasyan, Hayk
Shafritz, Adam B.
Viscomi, Christopher M.
author_facet Farhang, Borzoo
Lesiak, Alex C.
Ianno, Daniel J.
Minasyan, Hayk
Shafritz, Adam B.
Viscomi, Christopher M.
author_sort Farhang, Borzoo
collection PubMed
description BACKGROUND AND AIMS: Intravenous regional anesthesia (IVRA) is utilized for upper extremity surgery, but higher tourniquet pressure and longer inflation time increase the risk of soft tissue and nerve injury. We investigated the duration and magnitude of elevated venous pressure during IVRA to assess the possibility of safely lowering the tourniquet pressure during surgery. MATERIAL AND METHODS: Twenty adult patients scheduled for distal upper extremity surgery were enrolled. An additional intravenous catheter was placed in the surgical arm connected to a digital pressure transducer for monitoring venous pressure. Venous pressure was recorded prior to IVRA and every 30 s after injection of local anesthetic (LA) until the completion of surgery. RESULTS: All 20 subjects completed the study without complication. Peak venous pressure was 340 mmHg in one patient which lasted for less than 30 s. Mean venous pressures fell below systolic blood pressure after 4.5 min in all cases except one. This patient had elevated venous pressures for 24 of 25 min of tourniquet time exceeding systolic blood pressure. The only statistically significant intraoperative factor associated with elevated venous pressure was elevated peak systolic pressure (P = 0.001). CONCLUSIONS: We found that the mean peak venous pressure was below systolic blood pressure in only 14 of the 20 subjects, and the peak injection pressure exceeded 300 mmHg in one patient. Another patient's venous pressure remained above systolic blood pressure for 24 of 25 min of tourniquet time. Current precautions to prevent LA toxicity may be insufficient in some patients and attempts to lower tourniquet pressures to just above systolic blood pressures soon after IVRA injection may result in toxicity, specifically if systolic pressure is elevated.
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spelling pubmed-63608862019-02-17 Venous pressure during intravenous regional anesthesia: Implications for setting tourniquet pressure Farhang, Borzoo Lesiak, Alex C. Ianno, Daniel J. Minasyan, Hayk Shafritz, Adam B. Viscomi, Christopher M. J Anaesthesiol Clin Pharmacol Original Article BACKGROUND AND AIMS: Intravenous regional anesthesia (IVRA) is utilized for upper extremity surgery, but higher tourniquet pressure and longer inflation time increase the risk of soft tissue and nerve injury. We investigated the duration and magnitude of elevated venous pressure during IVRA to assess the possibility of safely lowering the tourniquet pressure during surgery. MATERIAL AND METHODS: Twenty adult patients scheduled for distal upper extremity surgery were enrolled. An additional intravenous catheter was placed in the surgical arm connected to a digital pressure transducer for monitoring venous pressure. Venous pressure was recorded prior to IVRA and every 30 s after injection of local anesthetic (LA) until the completion of surgery. RESULTS: All 20 subjects completed the study without complication. Peak venous pressure was 340 mmHg in one patient which lasted for less than 30 s. Mean venous pressures fell below systolic blood pressure after 4.5 min in all cases except one. This patient had elevated venous pressures for 24 of 25 min of tourniquet time exceeding systolic blood pressure. The only statistically significant intraoperative factor associated with elevated venous pressure was elevated peak systolic pressure (P = 0.001). CONCLUSIONS: We found that the mean peak venous pressure was below systolic blood pressure in only 14 of the 20 subjects, and the peak injection pressure exceeded 300 mmHg in one patient. Another patient's venous pressure remained above systolic blood pressure for 24 of 25 min of tourniquet time. Current precautions to prevent LA toxicity may be insufficient in some patients and attempts to lower tourniquet pressures to just above systolic blood pressures soon after IVRA injection may result in toxicity, specifically if systolic pressure is elevated. Medknow Publications & Media Pvt Ltd 2018 /pmc/articles/PMC6360886/ /pubmed/30774232 http://dx.doi.org/10.4103/joacp.JOACP_69_16 Text en Copyright: © 2019 Journal of Anaesthesiology Clinical Pharmacology http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Original Article
Farhang, Borzoo
Lesiak, Alex C.
Ianno, Daniel J.
Minasyan, Hayk
Shafritz, Adam B.
Viscomi, Christopher M.
Venous pressure during intravenous regional anesthesia: Implications for setting tourniquet pressure
title Venous pressure during intravenous regional anesthesia: Implications for setting tourniquet pressure
title_full Venous pressure during intravenous regional anesthesia: Implications for setting tourniquet pressure
title_fullStr Venous pressure during intravenous regional anesthesia: Implications for setting tourniquet pressure
title_full_unstemmed Venous pressure during intravenous regional anesthesia: Implications for setting tourniquet pressure
title_short Venous pressure during intravenous regional anesthesia: Implications for setting tourniquet pressure
title_sort venous pressure during intravenous regional anesthesia: implications for setting tourniquet pressure
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6360886/
https://www.ncbi.nlm.nih.gov/pubmed/30774232
http://dx.doi.org/10.4103/joacp.JOACP_69_16
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