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Article
October 11, 1965

Regional Intravenous Anesthesia

JAMA. 1965;194(2):210. doi:10.1001/jama.1965.03090150102038

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Abstract

To the Editor:—  The editorial in The Journal of July 26 (193:300, 1965) entitled "Regional Intravenous Anesthesia" in an example of its use describes the reduction of Colles fracture. A tourniquet is required; an Esmarch's bandage is optional.No comment is made with regard to the potential dangers of interruption of arterial flow to the extremity. Colles fracture almost invariably occurs in the afternoon of life, when vessels are stiff and tissues, particularly nerves, do not endure anoxia kindly. Irreversible injury can and occasionally does occur.The following simple rules have served me well for many years in keeping complications from the use of Esmarch's bandages and tourniquets to a minimum:

  1. Circulation is never interrupted nor a limb exsanguinated if (a) the patient is over 45 years of age; (b) there is any history or objective evidence of any sort of peripheral vascular disease, arterial or venous; or

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