An Unusual Phenomenon of Tourniquet-induced Hypertension in a Young Adult Male Undergoing Lower Limb Surgery under Subarachnoid Block: A Case Report
Correspondence Address :
Dr. Mridul Madhav Panditrao,
Professor and Head, Department of Anaesthesiology and Intensive Care, Adesh Institute of Medical Sciences and Research, Bathinda-151001, Punjab, India.
E-mail: drmmprao1@gmail.com
The employment of tourniquet to achieve bloodless surgical field is an essential step, especially in upper/lower extremity orthopaedic surgical procedures. However, tourniquet itself can lead to many possible problems, posing challenges to the anaesthesiologists. One such is exaggerated hypertensive response sometime after inflation of tourniquet, aptly termed as Tourniquet-induced Hypertension (TIH/T-HTN). It may not be evident in some patients, but if and once established, it becomes practically impossible to minimise/reverse it. This can be a nightmarish experience for the anaesthesiologist concerned. The authors hereby present one such case where, a young, healthy 25-year-old male posted for arthroscopy of right knee, who was administered subarachnoid block with dexmedetomidine as an adjuvant to bupivacaine. Within 35 to 40 minutes of inflating the torniquet, he developed severe hypertensive response, with blood pressures ranging from a Systolic Blood Pressure (SBP) of 190 to 210 mmHg and a Diastolic Blood Pressure (DBP) of 118 to 125 mmHg. It remained unresponsive to any form of treatment, including, the sedation with Inj. Midazolam or incremental doses of Inj. Labetalol. The hypertension persisted throughout the duration of surgery, while patient remained comfortably asleep. However, at the end of the surgical procedure, as soon as the tourniquet was deflated, the Blood Pressures (BPs), both SBP and DBP dropped to baseline values. Also, includes an in-depth review of the available literary evidence about this phenomenon and provided specific deductions and recommendations/remedial measures.
Anaesthesiologist, Hypertensive response, Knee arthroscopy, Spinal analgesia
DOI: 10.7860/JCDR/2025/74363.20471
Date of Submission: Jul 23, 2024
Date of Peer Review: Sep 03, 2024
Date of Acceptance: Oct 05, 2024
Date of Publishing: Jan 01, 2025
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. No
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ETYMOLOGY: Author Origin
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