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Chest. 2012 Aug;142(2):467-475. doi: 10.1378/chest.11-2246.

Effect of combined remote ischemic preconditioning and postconditioning on pulmonary function in valvular heart surgery.

Author information

1
Department of Anesthesiology and Pain Medicine, Kyungpook National University Hospital, Daegu.
2
Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
3
Division of Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, South Korea.
4
Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea. Electronic address: ylkwak@yuhs.ac.
5
Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea; Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea.

Abstract

BACKGROUND:

The aim of this study was to evaluate the lung-protective effect of combined remote ischemic preconditioning (RIPCpre) and postconditioning (RIPCpost) in patients undergoing complex valvular heart surgery.

METHODS:

In this randomized, placebo-controlled, double-blind trial, 54 patients were assigned to an RIPCpre plus RIPCpost group or a control group (1:1). Patients in the RIPCpre plus RIPCpost group received three 10-min cycles of right-side lower-limb ischemia of 250 mm Hg at both 10 min after anesthetic induction and weaning from cardiopulmonary bypass. The primary end point was to compare postoperative Pao(2)/Fio(2). Secondary end points were to compare pulmonary variables, incidence of acute lung injury, and inflammatory cytokines.

RESULTS:

In both groups, Pao(2)/Fio(2) at 24 h postoperation was significantly decreased compared with 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 IL-6, IL-8, IL-10, and tumor necrosis factor-α were all significantly increased in both groups compared with each corresponding baseline value, without any significant intergroup differences. There were also no significant differences in transpulmonary gradient of IL-6, IL-10, and tumor necrosis factor-α between the groups.

CONCLUSIONS:

RIPCpre plus RIPCpost as tested in this randomized controlled trial did not provide significant pulmonary benefit following complex valvular cardiac surgery.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT01427621.

PMID:
22281799
DOI:
10.1378/chest.11-2246
[Indexed for MEDLINE]

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