• Jason van der Velde, Leon Serfontein, and Gabriella Iohom.
• Department of Anaesthetics and Intensive Care, Cork University Hospital, Cork, Ireland.
• Eur J Emerg Med. 2013 Dec 1;20(6):391-6.

ObjectiveInvestigate a strategy to minimize tourniquet-associated reperfusion injury.MethodsSixteen healthy patients scheduled for repair of bimalleolar ankle fractures were randomized into two groups. In the standard release group (R, n1=6), the tourniquet was fully deflated at the end of surgery. In the staggered release group (SR, n2=10), the tourniquet was fully deflated for 30 s and subsequently reinflated to 300 mmHg. The procedure was repeated twice at 3 min intervals before complete removal. Haemodynamic and blood biochemistry measurements were obtained from an indwelling arterial catheter immediately before the initial tourniquet deflation and thereafter at 1, 4, 7 and 15 min.ResultsSerum Ca concentrations were less in group R at 4 min (1.027 ± 0.5 vs. 1.084 ± 0.07 mmol/l, P=0.046) and 7 min (1.045 ± 0.04 vs. 1.110 ± 0.06 mmol/l, P=0.013). The serum lactate concentration was higher in group R compared with group SR at 1 min (1.75 ± 0.19 vs. 1.33 ± 0.31 mmol/l, P=0.005) and 4 min (1.98 ± 0.23 vs. 1.48 ± 0.39 mmol/l, P=0.007), respectively. End-tidal CO2 was less in group SR compared with group R at 1 min (4.82 ± 0.45 vs. 5.68 ± 0.26 kPa, P=0.0004) and 4 min (5.01 ± 0.59 vs. 5.68 ± 0.35 kPa, P=0.01), respectively. At 15 min, less hypotension and bradycardia was noted in group SR.ConclusionA staggered tourniquet release was associated with greater haemodynamic stability and reduced the rate of acute systemic metabolic changes associated with limb reperfusion. Reapplication of a tourniquet seemed to halt further reperfusion, providing a window period for patient evaluation and management.

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