BSOA Project Grant

The successful applicant for the BSOA Project Grant was:

Principal Applicant
Dr Anuraag Guleria
Royal Manchester Children's Hospital

The effect of paediatric tourniquets on tissue oxygenation levels using Near Infra-Red Spectroscopy (NIRS) - a feasibility study


Scientific Abstract
Tourniquets are routinely applied in certain surgeries to reduce blood loss and to improve the surgical view of the operating field. They are however, not without their complications; pain; hyperthermia, acidosis, thromboembolism, nerve damage, paralysis, rhabdomyolysis, compartment syndrome and muscle weakness. Current guidance on the safe use of tourniquets is not evidence based and in children it is adapted from adult practice, for which evidence was generally based on animal studies. NIRS is non-invasive and routinely used in paediatric cardiac surgery to monitor cerebral tissue oxygenation and protect against ischaemia during periods of critical perfusion, it has also been used to measure somatic tissue oxygenation in muscle tissue and within the liver.

Utilising NIRS we aim to review the drop in tissue oxygenation (RsO2) and time to recovery from ischaemia in order to identify any correlation between tourniquet inflation time and tourniquet inflation pressure. Patient control = the non-operated limb. Other measurement parameters: FiO2, ETCO2, SpO2 and NIBP.

10 cases required for Pilot Study. Inclusion Criteria: ASA Class 1 or 2; Age 5 - 15 years. Exclusion criteria: Patient/parental refusal, contraindication to tourniquet use, regional or neuraxial blockade, vascular pathology, myopathy or neuropathy, blood disorders, skin sensitivity or allergy, contralateral limb pathology.