Complications of and improvements in pneumatic tourniquets used in surgery.

In North America, it is estimated that at least 10,000 pneumatic tourniquets are used in more than 1 million surgical procedures annually. The increasingly widespread use of pneumatic tourniquets in surgery of the extremities has been accompanied by continuing reports of injuries. Interest in tourniquet-induced complications has recently increased because of concern about potential legal liability. Results are presented from the investigation of 15 cases of complications suspected of being associated with the use of pneumatic tourniquets over an 18-month period. Factors leading to tourniquet-induced complications are identified, difficulties preventing an accurate estimate of the true incidence of such complications are reviewed, and the key elements of a program of inspections aimed at periodically assessing the safety and performance of pneumatic tourniquets are outlined. To reduce the hazards associated with the use of pneumatic tourniquets, a new microprocessor-based tourniquet is being developed. Initial results on a series of 30 patients indicate that the new microprocessor-based tourniquet-in addition to being significantly safer, more accurate, and more reliable-will considerably reduce operating costs by reducing the labor-intensiveness currently associated with tourniquet usage.