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Med Princ Pract. 2018 Nov 5. doi: 10.1159/000495110. [Epub ahead of print]

Does Tourniquet Time or Pressure Contribute to Intracranial Pressure Increase Following Tourniquet Application?



The aim of this study was to determine whether an early increase in intracranial pressure (ICP) following the deflation of a tourniquet is related to the tourniquet time (TT) or tourniquet pressure (TP) and to identify a safe cutoff value for TT or TP.


Patients who underwent elective orthopedic lower extremity surgery under general anesthesia were randomized into two groups: Group A, inflation with a pneumatic TP of systolic blood pressure + 100 mmHg (n = 30) and Group B, inflation using the arterial occlusion pressure formula (n = 30). The initial and maximum TPs, TT, and sonographic measurements of optic nerve sheath diameter (ONSD) and end tidal CO2 values were taken at specific time points (15 minutes before the induction of anesthesia, just before, and 5, 10, and 15 minutes after the tourniquet was deflated).


The initial and maximum TPs were found to be significantly higher in Group A compared to Group B. The fifth minute after the tourniquet deflation period showed a significant positive correlation between the TT and ONSD (r = 0.57, p = 0.0001). When ONSD ≥ 5mm was taken as a standard criterion, the safe cutoff value for the optimal tourniquet time was found to be < 67.5 minutes (sensitivity 87%, specificity 59.5%).


The ICP increase in the early period after tourniquet deflation was well correlated with TT but not with TP. The TT of ≥ 67.5 minutes was found to be the cutoff value, which is considered the start point of the increase in ICP after tourniquet deflation.

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