Effect of High-Dose Vitamin C on Oxygen Free Radical Production and Myocardial Enzyme after Tourniquet Ischaemia–Reperfusion Injury during Bilateral Total Knee Replacement

Abstract

This study investigated the effects of highdose vitamin C on oxygen free radical production and cardiac enzymes after tourniquet application and ischaemiareperfusion injury during bilateral total knee replacement (TKR) in elderly patients. In the vitamin C (VC) group (VC group, n = 16), during surgery, patients received a priming bolus of 0.06 g/kg vitamin C with 100 ml saline followed by 0.02 g/kg vitamin C mixed with 30 ml saline, intravenously. The control group (n = 16) received no intra-operative vitamin C. In the VC group, malondialdehyde levels were lower, and arterial oxygen tension and mean blood pressure were higher, than in controls after post-operative deflation of both knee tourniquets. Troponin I levels were lower in the VC group than in controls 8 h postoperation.Administering high-dose vitamin C during bilateral TKR could prevent oxygen free radical production and a decline in arterial oxygen tension and mean blood pressure induced by ischaemia-reperfusion injury, thereby protecting the myocardium.

Different oxidative stress marker levels in blood from the operated knee or the antecubital vein in patients undergoing knee surgery: A tourniquet-induced ischemia–reperfusion model

“…In the last 10 years, it has been shown in several papers made in patients undergoing knee surgery with tourniquet ischemia, increases of lipid peroxidation markers in systemic blood (venous or arterial), measuring the concentration of TBARS (TBA reacting substance), MDA, F2-isoprostanes, or isofurans ischemia. [4][5][6][7][8][9][10][11][17][18][19] The main finding for our study was that reduced glutathione and polyunsaturated fatty acids were oxidized very quickly with an increase in a 100% of GSSG and MDA blood levels, but coinciding with a decrease in GSH levels at T 1 -T 3 in blood drained from operated knee (group K). These increases in GSSG and MDA blood levels were also observed in peripheral blood from a forearm vein (group V) at T 1 and T 2 , but at lower levels than in blood from the operated knee.…”

“…2,3 Lipids peroxidation is a chain reaction leading to oxidation of polyunsaturated fatty acids which break the structure of biological membranes and produce toxic metabolites such as malondialdehyde (MDA) and other stable degradation products of lipid peroxides, which play an important role in reperfusion damage because they act locally but also act in other distant organs as lungs and circulatory system. [4][5][6][7][8][9][10][11] Also recently have been reported two studies on tourniquet-induced I-R injury during lower extremity surgery, showing DNA damage in peripheral blood lymphocytes. 12,13 So far all studies on oxidative stress in patients undergoing knee surgery have used the systemic blood, usually from an arm vein or the radial artery.…”

Interventions to reduce tourniquet‐related ischaemic damage in orthopaedic surgery: a qualitative systematic review of randomised trials

“…Four studies examined antioxidant interventions (Table ). One study examined both propofol and N‐acetyl‐cysteine, but propofol was used in a sub‐anaesthetic dose and we therefore categorised it in the antioxidant intervention group .…”

“…One study examined the effect of vitamin C in patients undergoing bilateral knee replacement . The authors reported no postoperative clinical outcomes or complications.…”

“…The other study concluded that ischaemic pre‐conditioning attenuated lipid peroxidation and the systemic inflammatory response, and mitigated pulmonary dysfunction. In addition, one study found that troponin I levels were significantly lower 8 h postoperatively in the patients given vitamin C compared with the control group . This is not a direct clinical outcome, but may indicate that a high oxidative stress level may be linked in some way to a poorer cardiovascular outcome.…”