Ankle tourniquet & thalassaemia
Hi Dieter,
I found the following references which may be of interest (despite being a bit old):
Adu-Gyamfi Y, Sankarankutty M, Marwa S. Use of a tourniquet in patients with sickle-cell disease.Can J Anaesth. 1993 Jan;40(1):24-7
Fifteen patients, 13 male and two female, known to be carrying the sickle-cell gene (12 HbSS and 3 HbAS), who were undergoing operations requiring a bloodless field, were included in the study. Of the 12 with HbSS, seven had haemoglobin A1 component of between 11 and 27%, three had fetal haemoglobin ranging from 5.7 to 29% and the remaining two had increased haemoglobin A2 concentrations suggesting a beta non-thalassaemia combination. All had a tourniquet applied to the appropriate limb and were given general anaesthesia with moderate hyperventilation throughout the procedure. The tourniquet inflation time was 61.7 +/- 27.5 min. The mean PaO2 remained above 200 mmHg, mean PaCO2 was less than 37 mmHg, and pH ranged between 7.40 and 7.45. There were no clinically important changes in BP or ECG. All patients made uneventful recoveries and none developed sickle-cell crises. It is suggested that it is safe to use tourniquet in patients with sickle-cell disease provided optimum acid-base status and oxygenation are maintained throughout the procedure.
Stein RE, Urbaniak J. Use of the tourniquet during surgery in patients with sickle cell hemoglobinopathies. Clin Orthop. 1980 Sep;(151):231-3.
Twenty-one patients carrying the sickle cell gene underwent 29 operative procedures using tourniquet-induced ischemia. No statistically increased incidence of complications occurred in the sickle cell group when compared with a control group of black patients who did not have the sickle cell trait, but who underwent similar operative procedures. There was no obvious contraindication to the use of the tourniquet in patients carrying the sickle cell gene.
Oginni LM, Rufai MB. How safe is tourniquet use in sickle-cell disease? Afr J Med Med Sci. 1996 Mar;25(1):3-6
Nineteen patients with sickle-cell haemoglobinopathy (HbSS-14; HbSC-5) aged five years to twenty-three years who had twenty orthopaedic operations performed under tourniquet at the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife between June 1987 and May 1991 were studied. The incidence of complications in these patients were compared with a control group of patients with HbAA who had similar operations under tourniquet and were matched for age and sex. There were seven patients with complications in the sickle cell anaemia group and three in the control group. Only three complications in the study group were significant. These were bone pains, severe post-operative pain and jaundice. Another complication was tissue oedema. The incidence of complications was significantly higher in the sickle cell patients than the normal group (P < 0.01). There were no mortalities. All complications resolved within two weeks of non-invasive management.
And there's an old JAPMA article : Willinsky JS, Lepow R. Sickle cell trait and use of the pneumatic tourniquet. A case report. J Am Podiatry Assoc. 1984 Jan;74(1):38-41
Good luck with it,
Lee
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