Comparative evaluation between ascorbic acid and N-acetyl cysteine for preventing tourniquet induced ischaemic reperfusion injury during lower limb surgery, a randomized controlled trial

Abstract

Tamer Yosef Hamawy (2016) Comparative evaluation between ascorbic acid and N-acetyl cysteine for preventing tourniquet induced ischaemic reperfusion injury during lower limb surgery, a randomized controlled trial, Egyptian

The effects of N‐acetylcysteine on recovery biomarkers: A systematic review and meta‐analysis of controlled trials

“…Only two studies conducted on patients with hepatic resections led to significant outcomes (Donadon et al, 2016; Sayed et al, 2017). In comparison, none of the other studies conducted on patients and healthy subjects found that NAC administration significantly altered lactate levels (Agusti et al, 1997; Ammar & Abdou, 2020; Bailey et al, 2011; Christensen & Bangsbo, 2019; Erturk et al, 2009; Kelly et al, 2009; Laisalmi‐Kokki et al, 2009; Leelarungrayub et al, 2011; Mohamed & Hamawy, 2016; Nielsen et al, 2001; Orban et al, 2006; Peake et al, 1996; Shafiei et al, 2018; Spapen et al, 1998; Steib et al, 1998; Steib et al, 2013; Trewin et al, 2013; Walsh et al, 1998). Although, we are aware of an in vivo study implemented by Monti et al proposing that oxidative stress induces the expression of monocarboxylate transporter 4 (MCT4) in stromal cells, which is also known as an exporter of glycolytic byproducts such as pyruvate and lactate.…”

“…In terms of gender distribution, 13 trials were conducted solely on male individuals (Bailey et al, 2011; Christensen & Bangsbo, 2019; Cobley et al, 2011; Kelly et al, 2009; Kerksick et al, 2010; Leelarungrayub et al, 2011; Michailidis et al, 2013; Nielsen et al, 2001; Orhan et al, 2006; Sakelliou et al, 2016; Sharma et al, 2017; Trewin et al, 2013; Zembron‐Lacny et al, 2009), whereas others were conducted on both genders. We categorized the study population into the following three groups: 25 studies on the patient (Agusti et al, 1997; Aliakbarian et al, 2017; Ammar & Abdou, 2020; Ayfer Aytemur et al, 2015; Donadon et al, 2016; Erdil et al, 2016; Erturk et al, 2009; Köksal et al, 2008; Kurian & Paddikkala, 2010; Laisalmi‐Kokki et al, 2009; Mahmoud & Ammar, 2011; Mohamed & Hamawy, 2016; Orban et al, 2006; Orhan et al, 2006; Peake et al, 1996; Peker et al, 2008; Rank et al, 2000; Sayed et al, 2017; Shafiei et al, 2018; Sharma et al, 2017; Song et al, 2015; Spapen et al, 1998; Steib et al, 1998; Steib et al, 2013; Walsh et al, 1998), 9 on trained (Christensen & Bangsbo, 2019; Cobley et al, 2011; Crum et al, 2018; Kelly et al, 2009; Kerksick et al, 2010; Michailidis et al, 2013; Nielsen et al, 2001; Trewin et al, 2013; Zembron‐Lacny et al, 2009), and 3 on healthy subjects (Bailey et al, 2011; Leelarungrayub et al, 2011; Sakelliou et al, 2016). Concerning the NAC administration form, 21 studies used the infusion form of NAC, and 16 others administr...…”

“…The low risk of bias in the randomization process of all included studies was stated. Regarding the deviations from the intended interventions, 14 trials were considered studies with a low risk of bias (Ammar & Abdou, 2020; Crum et al, 2018; Donadon et al, 2016; Erturk et al, 2009; Köksal et al, 2008; Leelarungrayub et al, 2011; Mahmoud & Ammar, 2011; Mohamed & Hamawy, 2016; Orhan et al, 2006; Peake et al, 1996; Sakelliou et al, 2016; Sharma et al, 2017; Song et al, 2015; Spapen et al, 1998), 3 with a high risk of bias (Kerksick et al, 2010; Orban et al, 2006; Shafiei et al, 2018), and there were also some concerns about remaining studies. When it comes to missing outcome data, five studies indicated a high risk of bias (Ammar & Abdou, 2020; Crum et al, 2018; Leelarungrayub et al, 2011; Mohamed & Hamawy, 2016; Shafiei et al, 2018), and there were some concerns about five others (Aliakbarian et al, 2017; Cobley et al, 2011; Nielsen et al, 2001; Orhan et al, 2006; Steib et al, 2013), whereas the majority of the trials indicated a low risk of bias.…”

The Impact of General Anesthesia on Redox Stability and Epigenetic Inflammation Pathways: Crosstalk on Perioperative Antioxidant Therapy

“…Mohamed et al studied the impact of perioperative intravenous administration of vitamin C and N-acetylcysteine on the production of malondialdehyde, IL-6, and IL-8 as markers for oxidative stress and systemic inflammation in patients needing a tourniquet during surgery; the study included 60 patients who had undergone surgical intervention of the upper limb and received 1 g of vitamin C and 10 mg/kg N-acetyl cysteine. Following statistical analysis, there was an increased expression of IL-6, IL-8, and malondialdehyde in patients who had not received antioxidant substances [ 231 ]. Rumelin et al studied the plasmatic concentration of vitamin C in the pre- and postoperative period following the administration of 1 g of single-dose vitamin C. For the study, the authors divided the patients into two groups: one group that received 1000 mg vitamin C preoperatively and one group that received a placebo.…”

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

“…Regarding NAC, it is a direct precursor to glutathione (GSH) which directly scavenges ROS and indirectly supports GSH peroxidase [ 59 ]. The beneficial effect of NAC on TQ-related I/R injury has been reported [ 60 , 61 ]. However, a high dose of NAC significantly increased urine markers indicating renal tubular damage [ 30 ].…”