Sir,We read with interest the article by Sharma JP and Salhotra R.1 At the outset, we would like to congratulate the authors, for having picked up such a contemporary and relevant topic to write a review article on.1The notion that a Doppler is a must to determine the tourniquet pressure seems to be a little misplaced. An average orthopedic surgeon, especially the one working in a not so well equipped centre may not have a Doppler machine or a hand-held Doppler at his disposal in the operating room. Is the method described by Bruner1 and given in Stewart's book of “Traction and orthopaedic appliances”2 of adding 50 to systolic pressure for upper limb and double the systolic pressure for lower limb, to determine the tourniquet pressure wrong or not be followed? The authors have not been clear on what is the best alternative method to determine tourniquet pressure if a Doppler machine is not available in the operating room. Can a pulse oximeter probe be used to determine the limb occlusion pressure? It would be kind of the authors to shed some light on the issue.