Rabdomiolisis asociada a torniquete en cirugía de rodilla: importancia del estrés oxidativo y el rol del alopurinol en su prevención / Rhabdomyolysis associated with tourniquet in knee surgery: importance of oxidative stress and the role of allopurinol in the prevention

ABSTRACT

Orthopedic knee surgery using a tourniquet has allowed surgeons to operate with a bloodless field. Nevertheless, tourniquet application produces an ischemia-reperfusion cycle in the skeletal muscle. As a consequence of the reoxygenation of the muscle, an enhancement on the production of reactive oxygen species leads to cell dysfunction, apoptosis and necrosis. A mild rhabdomyolisis is ascertained from the average 7-fold increase in plasma creatine phosphokinase and myoglobin in these patients, with release of intracellular content such as uric acid and phosphate. Altogether, these factors ascertain a distant response, determined by systemic inflammation and renal involvement by means of glomerular and tubular damage. In contrast, it is likely that acute kidney injury remains under diagnosed due to the recent change in acute kidney failure diagnostic paradigm. As a plausible evidence-based intervention, a diminution on the production of reactive oxygen species seems the pathophysiological treatment. Indeed, allopurinol supplementation constitutes a reasonable, innocuous and cheap alternative for these patients, because of inhibition of xanthine oxidase, the latter being the main source of reactive oxygen species in the setting of ischemia-reperfusion. This review focuses on the pathophysiology of rhabdomyolisis and acute kidney injury in the context of tourniquet knee surgery and therapeutics on allopurinol.