Surgery – Instruments – External pressure applicator
Patent
1997-06-11
1999-01-05
Lewis, William
Surgery
Instruments
External pressure applicator
600499, A61B 1712
Patent
active
058555897
DESCRIPTION:
BRIEF SUMMARY
FIELD OF THE INVENTION
This invention pertains to automated tourniquet apparatus for use in surgery. In particular, the invention pertains to tourniquet apparatus having a safety interlock for improved safety in surgical procedures involving the use of intravenous regional anesthesia.
BACKGROUND OF THE INVENTION
This invention pertains to apparatus for improving safety in the administration and management of intravenous regional anesthesia (IVRA) for both upper and lower limbs. IVRA is an alternative to general anesthesia for limb surgery. IVRA has proven to be a simple and useful technique for satisfactorily anesthetizing the upper limb and is potentially well suited for greatly expanded utilization in surgery of lower limbs and in outpatient settings. In these settings, which are rapidly increasing in number worldwide, there is a large and unmet need for a rapid, simple, safe and reliable technique for establishing limb anesthesia. However, significant practical problems with the technology of IVRA in the prior art have limited the acceptance of this promising technique.
IVRA is an anesthetic technique which requires the use of a pneumatic surgical tourniquet system. Surgical tourniquet systems of the prior art typically include an inflatable cuff for encircling a limb and an automatic pressure regulator for maintaining a pressure applied by the cuff to the limb near a reference pressure selected by an operator or determined automatically. Surgical tourniquet systems are frequently used on the upper and lower limbs to help maintain a bloodless operative field by regulating the maximum pressure applied to the limb by an encircling cuff at a pressure sufficient to stop arterial blood flow past the cuff for the duration of a surgical procedure. A "physiologic tourniquet" system is generally considered to be one which has the capability of maintaining the pressure applied by the cuff to the limb near the minimum pressure required to stop the flow of arterial blood past the cuff during the surgical procedure.
During surgical procedures performed under IVRA, the surgical tourniquet system serves an additional role of preventing liquid anesthetic agent introduced into the veins in the limb distal to the cuff from flowing proximally past the cuff and out of the limb into the circulatory system. For surgical procedures where IVRA is to be employed, special cuffs having dual bladders are often used for encircling the limb, resulting in a first bladder encircling the limb above a second bladder which also encircles the same limb distal to the first bladder. Alternatively, two separate single-bladder cuffs can be applied to the same limb. To maintain the pressures applied by one dual-bladder cuff or two single-bladder cuffs near selected reference pressures, one tourniquet instrument having a dual-channel automatic pressure regulator may be employed, or two separate tourniquet instruments, each having one automatic pressure regulator, may be employed. Regardless of whether one dual-bladder cuff or two separate cuffs are used, and regardless of whether one dual-channel tourniquet instrument or two single-channel tourniquet instruments are used, surgical procedures involving IVRA are typically conducted as follows.
IVRA is typically administered as follows. A dual-bladder cuff is first applied to the limb on which surgery is to be performed, so that the first and second inflatable bladders of the cuff encircle the same limb, with the first cuff bladder being located proximal to the second, and so that both cuff bladders are located between the heart and the operative site on the limb. The portion of the limb distal to both bladders is then exsanguinated, often by wrapping the limb with an elastic bandage, beginning at the end of the limb and wrapping tightly towards the heart up to the cuff location. While the limb is thus exsanguinated, the tourniquet instrument is typically used to inflate the first (proximal) cuff and maintain it at a first predetermined cuff pressure sufficient to stop the inflow of arterial b
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Jameson Michael
McEwen James A.
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