Review Article

The Possible Pathophysiological Outcomes and Mechanisms of Tourniquet-Induced Ischemia-Reperfusion Injury during Total Knee Arthroplasty

Table 6

Effects of pharmacological intervention on TQ-induced I/R injury in TKA.

Study model/specimen/TQ pressureDrug/dose/TQ ischemia time/sample size/ageMain findings (compared between groups)InterpretationReferences
InterventionControl

RCT/venous bloodVitamin C, 0.03 g/kg during ischemia then 0.01 g/kg after reperfusion, 91 ± 11 min, , 71 ± 4 yrNormal saline, 91 ± 14 min, , 70 ± 4 yrSerum MDA
Serum troponin I
Vitamin C group < control
High-dose vitamin C prevents oxygen free radical production and may have myocardial protection properties[31]
RCT/vastus lateralis muscle biopsy/double SBP mmHgMannitol, 930 mosmol/kg, 12.5 mL/kg/day, 75–93 min, , 64–74 yr5% glucose, 18.75 mL/kg/day, 50–88 min, , 62–79 yrMuscle GSH, tGSH
Muscle amino acid
Mannitol group ↔ control
No positive effects of mannitol in this TQ-induced I/R model[11]
RCT/venous blood, quadriceps femoris muscle biopsy/300 mmHgiNO, 80 ppm entire operation, 101 ± 20 min, , 63 ± 14 yr
Partial iNO,
80 ppm during operation except ischemia period, 103 ± 19 min, , 65 ± 9 yr
Nitrogen, 95 ± 19 min, , 64 ± 9 yrPlasma ICAM, VCAM
Plasma P-selectin, E-selectin
CD68+ macrophage expression
Expression of ICAM, VCAM, P-selectin
iNO, partial iNO groups ↔ control
No beneficial effects of iNO in this TQ-induced I/R model[55]
RCT/antecubital venous blood/200 mmHgLower O2 tension, , 61–110 min, , 66–77 yrHigher O2 tension, , 86–107 min, , 62–74 yrPlasma isofurans
Lower FiO2 < higher FiO2
Elevated O2 tension during general anesthesia reflects increased oxidative stress[53]
RCT/venous blood, urine/300–350 mmHgNAC, 150 mg/kg before ischemia then 6.25 mg/kg/h during ischemia, 77–113 min, , 62–77 yr5% glucose, 83–121 min, , 64–73 yrUrine α-1-microglobulin/Cr ratio
Urine NAG/Cr ratio
Urine myoglobin
NAC group > control
High-dose NAC may aggravate proximal tubular injury[30]

Cr: creatinine; FiO2: fraction of inspired oxygen; GSH: reduced glutathione; ICAM: intercellular adhesion molecule; iNO: inhaled nitric oxide; I/R: ischemia and reperfusion; MDA: malondialdehyde; NAC: N-acetylcysteine; NAG: N-acetyl-β-D-glucosaminidase; RCT: randomized controlled trial; tGSH: total glutathione; TQ: tourniquet; VCAM: vascular adhesion molecule.