A single pneumatic tourniquet is superior to wide rubber tourniquets for saphenous intravenous regional limb perfusion with amikacin in standing, sedated horses.

Abstract

OBJECTIVE: To establish whether tourniquet type and number influence synovial fluid amikacin concentrations of the tarsocrural joint (TCJ) or metatarsophalangeal joint (MTPJ) after standing saphenous IV regional limb perfusion (IVRLP) with 2 g of amikacin. METHODS: 8 healthy adult horses underwent 4 saphenous IVRLP protocols with amikacin, differing in tourniquet type (pneumatic vs wide rubber) and number (1 placed mid-gaskin vs 1 placed mid-gaskin and 1 mid-metatarsus) in a randomized, crossover design. Amikacin concentrations were measured in serum and synovial fluid of the TCJ and MTPJ at 15 and 30 minutes after perfusate administration. A linear mixed-effects model was used to compare amikacin concentrations between protocols and within joints. RESULTS: Mean synovial fluid amikacin concentrations were not different between the single-tourniquet protocols but were higher with the dual pneumatic protocol compared to the dual wide rubber protocol. Mean synovial fluid amikacin concentrations were not different between single and dual pneumatic protocols. Mean TCJ synovial fluid amikacin concentrations were higher with the single wide rubber protocol compared to the dual wide rubber protocol, but those in the MTPJ were not different. Pneumatic tourniquets resulted in lower serum amikacin concentrations compared to wide rubber tourniquets. CONCLUSIONS: Single-tourniquet protocols yield synovial fluid amikacin concentrations in the TCJ and MTPJ similar to or higher than those of dual-tourniquet protocols, and wide rubber tourniquets result in more systemic leakage of amikacin compared to pneumatic tourniquets during saphenous IVRLP. CLINICAL RELEVANCE: A single mid-gaskin pneumatic tourniquet should be considered over multiple tourniquets of either type when saphenous IVRLP is performed in standing, sedated horses.