Arterial hypertension associated with the use of a tourniquet with either general or regional anaesthesia

Publisher Website
Google Scholar
Abstract
A hypertensive patient with left cardiac enlargement developed marked hypertension under general anesthesia, during which time a tourniquet was applied around his thigh. When the tourniquet was released, severe hypotension ensured which responded to therapy. The patient, however, died 16 h later of a myocardial infarction. Because of this incident, the anesthetic and hemodynamic data of 699 patients who underwent limb surgery with a pneumatic tourniquet inflated for at least an hour were retrospectively examined using multivariate analysis. A 30% increase in systolic and/or diastolic arterial blood pressure occurred in 27% of the total patient material and in 67% of those who had had a general anesthetic. There was a higher frequency of the occurrence of "tourniquet hypertension" with older age, longer operations and the operation site being the lower rather than the upper limb. Tourniquet hypertension rarely occurred in patients with spinal anesthesia (2.7%) and brachial plexus blockade (2.5%), while those with intravenous regional anesthesia had a higher incidence (19%) of hypertension.