Table 6.
Effects of pharmacological intervention on TQ-induced I/R injury in TKA.
| Study model/specimen/TQ pressure | Drug/dose/TQ ischemia time/sample size/age | Main findings (compared between groups) | Interpretation | References | |
|---|---|---|---|---|---|
| Intervention | Control | ||||
| RCT/venous blood | Vitamin C, 0.03 g/kg during ischemia then 0.01 g/kg after reperfusion, 91 ± 11 min, n = 16, 71 ± 4 yr | Normal saline, 91 ± 14 min, n = 16, 70 ± 4 yr | Serum 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 mmHg | Mannitol, 930 mosmol/kg, 12.5 mL/kg/day, 75–93 min, n = 8, 64–74 yr | 5% glucose, 18.75 mL/kg/day, 50–88 min, n = 7, 62–79 yr | Muscle 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 mmHg | iNO, 80 ppm entire operation, 101 ± 20 min, n = 15, 63 ± 14 yr Partial iNO, 80 ppm during operation except ischemia period, 103 ± 19 min, n = 15, 65 ± 9 yr |
Nitrogen, 95 ± 19 min, n = 15, 64 ± 9 yr | Plasma 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 mmHg | Lower O2 tension, FiO2 = 0.4, 61–110 min, n = 19, 66–77 yr | Higher O2 tension, FiO2 = 0.5, 86–107 min, n = 20, 62–74 yr | Plasma isofurans Lower FiO2 < higher FiO2 |
Elevated O2 tension during general anesthesia reflects increased oxidative stress | [53] |
| RCT/venous blood, urine/300–350 mmHg | NAC, 150 mg/kg before ischemia then 6.25 mg/kg/h during ischemia, 77–113 min, n = 15, 62–77 yr | 5% glucose, 83–121 min, n = 15, 64–73 yr | Urine 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.