Limb torniquet
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Consider hyperventilating prior to release of the torniquet to mitigate the acidemia and rise in pCO2.

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Cuff pressure should be set to 100mmHg over systolic blood pressure. Maximum 250mmHg for the lower limb, and 200mmHg for the upper limb. #rev

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Cuff width must be at least 2/3rd of the limb circumference

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Ensure that the deflation alarms are functioning.

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Be alert for haemodynamic changes on deflation of the torniquet. This includes hypotension and arrhythmias related to metabolic acidosis and electrolyte abnormalities

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Consider having vasopressors drawn up to manage the systemic hypotension seen after prolonged torniquet time for those patients in which hypotension is undesirable (eg elderly, IHD, raised intracranial pressure)

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Maximum torniquet time is 120mins. If requiring additional operating time, deflate the torniquet for 20mins and then reinflate.

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Potential LOCAL complications:
- skin bruising;
- rhabdomyolisis;
- nerve damage (pressure or ischaemia);
- skin tearing (esp with poor skin integrity)

Potential SYSTEMIC complications:
- CVS (tachycardia, hypertension)
- Metabolic (metabolic acidosis on release of torniquet)
- Respiratory (hypercapnia)
- Haematological (caution with sickle cell-anemia)
- CNS (hypercarbia increases intracranial pressure)
- Pain
- Embolisation of thrombi during exsanguination
- Failure of torniquet
- Bleeding (failure of torniquet)
- Local anesthetic-toxicity ( Biers block)

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