Tourniquet-induced systemic inflammatory response in extremity surgery.
BACKGROUND
Tourniquet-induced reperfusion injury in animals produces significant systemic inflammatory effects. This study investigated whether a biologic response occurs in a clinically relevant model of tourniquet-induced reperfusion injury.


METHODS
Patients undergoing elective knee arthroscopy were prospectively randomized into controls (no tourniquet) and subjects (tourniquet-controlled). The effects of tourniquet-induced reperfusion on monocyte activation state, neutrophil activation state, and transendothelial migration (TEM) were studied. Changes in the cytokines implicated in reperfusion injury, tumor necrosis factor-alpha, interleukin (IL)-1beta, and IL-10 were also determined.


RESULTS
After 15 minutes of reperfusion, neutrophil and monocyte activation were significantly increased. Pretreatment of neutrophils with pooled subject (ischemia-primed) plasma significantly increased TEM. In contrast, TEM was not significantly altered by ischemia-primed plasma pretreatment of the endothelial monolayer. Significant elevation of tumor necrosis factor-alpha and IL-1beta were observed in subjects compared with controls after 15 minutes of reperfusion. There was no significant difference in serum IL-10 levels between the groups at all the time points studied.


CONCLUSIONS
These results indicate a transient neutrophil and monocyte activation after tourniquet-ischemia that translates into enhanced neutrophil transendothelial migration with potential for tissue injury.
Wakai
A
A
Department of Academic Surgery, Cork University Hospital, Cork, Ireland.
Wang
J H
JH
Winter
D C
DC
Street
J T
JT
O'Sullivan
R G
RG
Redmond
H P
HP
D000328:Adult; D000704:Analysis of Variance; D019645:Arthroplasty, Replacement, Knee; D018845:CD11 Antigens / Q000097:blood; D002464:Cell Migration Inhibition; D002478:Cells, Cultured; D016207:Cytokines / Q000097:blood; D005260:Female; D006801:Humans; D018950:Lipopolysaccharide Receptors / Q000097:blood; D008297:Male; D009504:Neutrophils / Q000276:immunology; D011446:Prospective Studies; D015427:Reperfusion Injury / Q000097:blood / Q000150:complications*; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000209:etiology*; D014111:Tourniquets / Q000009:adverse effects*
D018845:CD11 Antigens; D016207:Cytokines; D018950:Lipopolysaccharide Receptors