Source
From the Department of Anesthesiology and Pain Medicine (Dr Kim), Kyungpook National University Hospital, Daegu, South Korea; Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute (Drs Shim, Yoo, Yang), Yonsei University College of Medicine, Seoul, South Korea; Division of Cardiovascular Surgery (Dr Lee), Yonsei University College of Medicine, Seoul, South Korea; Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Severance Biomedical Science Institute (Dr Kwak), Yonsei University College of Medicine, Seoul, South Korea.
Abstract
Abstract:
BACKGROUND:
The aim of this study was to evaluate the lung-protective effect of combined remote ischemic pre- and post-conditioning (RIPC(pre) plus RIPC(post)) in patients undergoing complex valvular heart surgery.
METHODS:
This was a randomized, placebo-controlled, and double-blind trial. Fifty-four patients were randomly allocated into the RIPC(pre) plus RIPC(post) group or Control group (1:1). Patients in the RIPC(pre) plus RIPC(post) group received three 10-min cycles of right lower limb ischemia of 250 mmHg at both 10 min after anesthetic induction and weaning from cardiopulmonary bypass. Primary endpoint was to compare postoperative PaO(2)/FiO(2). Secondary endpoints were to compare pulmonary variables, incidence of acute lung injury and inflammatory cytokines.
RESULTS:
In both groups, PaO(2)/FiO(2) at 24 h after operation was significantly decreased compared to each corresponding baseline value. However, intergroup comparisons of pulmonary variables including PaO(2)/FiO(2) and incidence of acute lung injury revealed no significant differences. Serum levels of interleukin-6, 8 and 10, and tumor necrosis factor-α were all significantly increased in both groups compared to each corresponding baseline value without any significant intergroup differences. There were also no significant differences in transpulmonary gradient of interleukin 6 and 10, and tumor necrosis factor-α between the groups.
CONCLUSIONS:
RIPC as tested in this RCT did not provide significant pulmonary benefit following complex valvular cardiac surgery.