Anesthetic Implications of Tourniquet Application in an Elderly Patient with Undiagnosed Peripheral Vascular Disease Undergoing Proximal Tibial ORIF: A Case Report

Abstract

Anesthetic implications, Peripheral Vascular Disease, Proximal Tibial ORIFabitat The use of pneumatic tourniquets in surgeries involving bones of the legs provides excellent visibilities; however, serious side effects may occur in elderly patients who have undiagnosed artery problems (peripheral vascular disease, PVD). Here, we report our experience with a 66-year-old female patient who had a closed fracture of the proximal part of the tibia and who had open reduction with internal fixation (ORIF) using a subarachnoid block and pneumatic tourniquet. During the operation, the physician noted poor pulse signals at a location below where the procedure was performed, heavily calcified arteries, and excessive blood loss, which suggested that the patient might have had hidden artery disease. Further delays in the work and the need to reverse the regional block, led to the change to general anesthesia, via lateral intubation. This situation shows how important a preoperative vascular assessment of patients may be, in addition to detailed monitoring of the patient while the surgery is being performed.