{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T00:33:47Z","timestamp":1788568427546,"version":"build-2803163510"},"reference-count":17,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2020,11,6]],"date-time":"2020-11-06T00:00:00Z","timestamp":1604620800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Osteogenesis imperfecta (OI) is a rare genetic connective-tissue disorder with bone fragility. To avoid iatrogenic fractures, healthcare providers have traditionally avoided using non-invasive blood pressure (NIBP) cuffs and extremity tourniquets in the OI population in the perioperative setting. Here, we hypothesize that these procedures do not lead to iatrogenic fractures or other complications in patients with OI. A retrospective study of all children with OI who underwent surgery at a single tertiary care children\u2019s hospital from 1998 to 2018 was performed. Patient positioning and the use of NIBP cuffs, arterial lines, and extremity tourniquets were documented. Fractures and other complications were recorded. Forty-nine patients with a median age of 7.9 years (range: 0.2\u201317.7) were identified. These patients underwent 273 procedures, of which 229 were orthopaedic operations. A total of 246 (90.1%) procedures included the use of an NIBP cuff, 61 (22.3%) an extremity tourniquet, and 40 (14.7%) an arterial line. Pediatric patients with OI did not experience any iatrogenic fractures related to hemodynamic monitoring or extremity tourniquet use during the 20-year period of this study. Given the benefits of continuous intra-operative hemodynamic monitoring and extremity tourniquets, we recommend that NIBP cuffs, arterial lines, and tourniquets be selectively considered for use in children with OI.<\/jats:p>","DOI":"10.3390\/children7110214","type":"journal-article","created":{"date-parts":[[2020,11,6]],"date-time":"2020-11-06T09:09:30Z","timestamp":1604653770000},"page":"214","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Perioperative Considerations in Osteogenesis Imperfecta: A 20-Year Experience with the Use of Blood Pressure Cuffs, Arterial Lines, and Tourniquets"],"prefix":"10.3390","volume":"7","author":[{"given":"Kirsten E.","family":"Ross","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN 37203, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph T.","family":"Gibian","sequence":"additional","affiliation":[{"name":"School of Medicine, Vanderbilt University, Nashville, TN 37203, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7394-318X","authenticated-orcid":false,"given":"Christy J.","family":"Crockett","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37203, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey E.","family":"Martus","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN 37203, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,11,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"17052","DOI":"10.1038\/nrdp.2017.52","article-title":"Osteogenesis imperfecta","volume":"3","author":"Marini","year":"2017","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.1016\/j.pcl.2014.08.010","article-title":"Update on the evaluation and treatment of osteogenesis imperfecta","volume":"61","author":"Harrington","year":"2014","journal-title":"Pediatr. Clin. N. Am."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1657","DOI":"10.1016\/S0140-6736(15)00728-X","article-title":"Osteogenesis imperfecta","volume":"387","author":"Forlino","year":"2016","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1111\/cge.12409","article-title":"A cross-sectional multicenter study of osteogenesis imperfecta in North America\u2014Results from the linked clinical research centers","volume":"87","author":"Patel","year":"2015","journal-title":"Clin. Genet."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"iii18","DOI":"10.1093\/bja\/aew358","article-title":"Perioperative management of the bleeding patient","volume":"117","author":"Ghadimi","year":"2016","journal-title":"Br. J. Anaesth."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.2106\/JBJS.M.01267","article-title":"Proper Patient Positioning and Complication Prevention in Orthopaedic Surgery","volume":"96","author":"Bonnaig","year":"2014","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1016\/j.bpa.2012.10.003","article-title":"Perioperative hemodynamic monitoring","volume":"26","author":"Cove","year":"2012","journal-title":"Best Pract. Res. Clin. Anaesthesiol."},{"key":"ref_8","unstructured":"Hines, R.L., and Marschall, K.E. (2008). Skin and Musculoskeletal Diseases. Stoelting\u2019s Anesthesia and Co-Existing Disease, Churchill Livingstone\/Elsevier. [5th ed.]."},{"key":"ref_9","unstructured":"Miller, R., Eriksson, L., Fleisher, L., Wiener-Kronish, J., and Young, W. (2010). Miller\u2019s Anesthesia, Churchill Livingstone. [7th ed.]."},{"key":"ref_10","unstructured":"(2020, July 25). American Society of Anesthesiologists: Standards for Basic Anesthetic Monitoring. Available online: http:\/\/www.asahq.org."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1093\/bjaceaccp\/mkv014","article-title":"Anaesthesia for paediatric lower limb surgery","volume":"16","author":"Lonsdale","year":"2015","journal-title":"BJA Educ."},{"key":"ref_12","unstructured":"Heinrich, S., Tzabazis, A., and Haag, S.O.S. (2020, July 25). Anesthesia Recommendations for Patients Suffering from Osteogenesis Imperfecta. Available online: https:\/\/www.orpha.net\/data\/patho\/Pro\/en\/Osteogenesis_EN.pdf."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e68","DOI":"10.1097\/BPO.0000000000001105","article-title":"Incidence of Fractures From Perioperative Blood Pressure Cuff Use, Tourniquet Use, and Patient Positioning in Osteogenesis Imperfecta","volume":"39","author":"Sullivan","year":"2019","journal-title":"J. Pediatr. Orthop."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1097\/ALN.0000000000000967","article-title":"Surgical and Patient Risk Factors for Severe Arterial Line Complications in Adults","volume":"124","author":"Nuttall","year":"2016","journal-title":"Anesthesiology"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1136\/neurintsurg-2018-013769","article-title":"Comparison of a pressure-sensing sheath and radial arterial line for intraoperative blood pressure monitoring in neurointerventional procedures","volume":"10","author":"Froehler","year":"2018","journal-title":"J. Neurointerv. Surg."},{"key":"ref_16","unstructured":"Stoelting, R., and Miller, R. (2007). Anesthetic Monitoring. Basics of Anesthesia, Churchill Livingstone. 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Control"}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/7\/11\/214\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:30:01Z","timestamp":1760178601000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/7\/11\/214"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,6]]},"references-count":17,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2020,11]]}},"alternative-id":["children7110214"],"URL":"https:\/\/doi.org\/10.3390\/children7110214","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11,6]]}}}