Pneumatic tourniquets (PTs) are commonly used in local anaesthetic cases in the upper limb to provide a bloodless operating field. They give excellent efficacy however their limitations have prompted the introduction of a new single-use sterile silicone ring tourniquet (SRT). The evidence of use of the SRT over the standard PT is limited. To compare the level of perceived pain, and therefore tolerance, of the Silicone Ring and Pneumatic tourniquets when applied to the upper arm and to evaluate whether there was a clear benefit of use of either tourniquet in local anaesthetic procedures of the upper limb.Introduction
Aim
Cerebral micro emboli have been noted to occur during both total hip and knee arthroplasty. These micro emboli have been implicated in the causation of postoperative cognitive impairment. The aim of this study was to determine whether cerebral micro emboli occur during hip fracture surgery. 28 patients undergoing hip fracture surgery had transcranial doppler assessment of the middle cerebral artery to detect cerebral micro emboli. Micro embolic signals (MESs) were recorded during the operative procedure. Successful monitoring was carried out in 26 patients. MES were recorded in 16 out of 26 patients. 12 out of 16 patients who had MESs had undergone a cemented hemiarthroplasty; the remainder had a sliding hip screw for an extracapsular hip fracture. 75% (9/12) of patients who had a cemented hemiarthroplasty had the majority of MESs after reaming and cementing. MESs in the patients who had a sliding hip screw occurred throughout the operative procedure.
We studied the use of Autologous blood transfusion drains (Bellovac ABT) in lower limb arthroplasty compared with standard closed suction drains. We studied 123 lower limb arthroplasty (61 TKR &
62 THR) to see if there was a significant reduction in the need for homologous blood transfusion when using re-transfusion drains and its cost effectiveness.
32 THR with standard drains: 14 male, 18 female, mean age 68.4, mean pre op Hb 12.96, mean post op Hb 9.36, mean volume drained 579.5ml. 24 patients (75%) required homologous blood transfusion. 30 TKR with ABT drains: 14 male, 16 female, mean age 69.8, mean pre-op Hb13.4, mean post-op Hb 11.03, mean volume re-transfused 415ml, mean volume drained 580ml. 4 patients (13%) required additional homologous blood transfusion. 31 TKR with Standard drains: 13 male, 18 female. Mean age72.1, mean pre-op Hb13.33, mean post-op Hb10.4, mean volume drained 711.5ml. 14 patients (45%) required homologous blood transfusion. No re-transfusion complications occurred in the ABT group. 2 patients requiring homologous blood had increasing pyrexia and transfusion hence stopped.