Tourniquet Induced Purpura During Hand Surgery - A Case Repo
A 44-year-old male was scheduled for an emergency left ring finger flexor tendon surgery following a knife injury. He was on medical management of diabetes mellitus (Oral hypoglycemic agents) for one year with no other co-morbidities. The patient was not a known hypertensive and did not have any history of easy bruising and bleeding disorders. Pre-operative blood investigations showed a Platelet count of 268 × 109/l, Hemoglobin 13.3 g/dl, a white cell count of 9.07×10 9/l, Bleeding time 2 min, Clotting time 6 min 30 sec and random blood sugar 84 mg/dl. Pre-operatively, BP was found to be 140/92 mm of Hg, Pulse rate 66/min and surgery was scheduled under Bier’s block (Intra venous regional anesthesia).

Upon arrival in the operating room, appropriately sized adult (24 cm) cuffs of Zimmer pneumatic tourniquet were applied for Bier’s block on his left arm above the elbow. His BP was continuously monitored at 10-minute intervals in other arm. His pre-induction BP was 163/89 mm Hg. The patient was given Bier’s block with 15 ml of 2 % Xylocard (Diluted with 25 cc NS) after adequate exsanguination of the involved limb. The pressure of the pneumatic tourniquet was kept at 250 mm of Hg. During the surgery, the patient showed BP fluctuations, ranging from 135/85-163/89 mmHg. The operative and regional anesthesia time was 71 and 90 minutes respectively....