Tourniquet use in childhood: a harmless procedure?
Tourniquet ischemia is widely used in limb surgery in every age group. In adults, tourniquet-related deep vein thrombosis and pulmonary embolism are recognized complications of tourniquet use. In healthy children, tourniquet-associated alterations of blood clotting physiology are assumed to have no clinical impact. Antithrombotic prophylaxis is, therefore, recommended only in the presence of pertinent risk factors such as extensive surgery, congenital thrombophilia, prolonged immobilization, and indwelling central venous line, however, it is not practiced in obese, otherwise healthy children. We describe the first case of fatal pulmonary thromboembolism in an obese 12-year and 3-month old boy (body mass index 27.6 kg x m(-2)) following tourniquet-deflation after minor surgery on the lower extremity.
Sinicina
Inga
I
Institute of Forensic Medicine, Ludwing-Maximilians Unversity, Munich, Germany. inga-sinicina@med-uni-muenchen.de
Bise
Karl
K
Hetterich
Reinhard
R
Pankratz
Helmut
H
D000925:Anticoagulants / Q000008:administration & dosage; D015992:Body Mass Index; D001926:Brain Death; D001929:Brain Edema / Q000209:etiology; D001993:Bronchodilator Agents / Q000008:administration & dosage; D016887:Cardiopulmonary Resuscitation / Q000379:methods; D002316:Cardiotonic Agents / Q000008:administration & dosage; D002648:Child; D003490:Cyanosis / Q000209:etiology; D004298:Dopamine / Q000008:administration & dosage; D017548:Echocardiography, Transesophageal / Q000379:methods; D004837:Epinephrine / Q000008:administration & dosage; D017809:Fatal Outcome; D005269:Femur / Q000601:surgery; D006323:Heart Arrest / Q000209:etiology; D006325:Heart Atria / Q000000981:diagnostic imaging; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D002534:Hypoxia, Brain / Q000209:etiology; D008297:Male; D009765:Obesity / Q000150:complications*; D011655:Pulmonary Embolism / Q000209:etiology*; D014111:Tourniquets / Q000009:adverse effects*
D000925:Anticoagulants; D001993:Bronchodilator Agents; D002316:Cardiotonic Agents; D006493:Heparin; D004298:Dopamine; D004837:Epinephrine