When the tourniquet tightens: A case series of haemodynamic complications in orthopaedic surgery

Pneumatic tourniquets are widely used in orthopaedic surgery to provide a bloodless operative field and limit blood loss. Although regarded as safe, their use is associated with physiological and clinical complications that may occasionally be severe. We conducted a retrospective review of prospectively collected data over a 5-year period for adverse haemodynamic events during tourniquet use. Five patients (approximate incidence of 0.25%) developed significant haemodynamic complications with tourniquet in situ. The reported complications included acute haemodynamic instability at the time of inflation and deflation, persistent bleeding despite tourniquet application, venous oozing from partial deflation, fat embolism syndrome, and delayed hypotension following release in revision arthroplasty. All patients improved with appropriate supportive management and recovered without long-term sequelae. Awareness of the risks of tourniquet use, with vigilant monitoring, and timely management are essential for patient safety. This series adds to the limited literature on tourniquet-related haemodynamic complications and underlines the importance of careful perioperative vigilance.