• Anesthesiology · Aug 2014

    Randomized Controlled Trial

    Limb Remote Ischemic Preconditioning Attenuates Lung Injury after Pulmonary Resection under Propofol-Remifentanil Anesthesia: A Randomized Controlled Study.

    Remote ischaemic preconditioning was induced using a BP cuff on one arm with three 5-min-ON / 5-min-OFF cycles before surgical start. Patients receiving RIPC before elective thoracotomy and pulmonary resection experienced less acute lung injury (indicated by PaO2/FiO2) and a 30% shorter hospital stay compared to those who did not receive RIPC.

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    • Cai Li, Miao Xu, Yan Wu, Yun-Sheng Li, Wen-Qi Huang, and Ke-Xuan Liu.
    • From the Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
    • Anesthesiology. 2014 Aug 1;121(2):249-59.

    BackgroundRemote ischemic preconditioning (RIPC) may confer the protection in critical organs. The authors hypothesized that limb RIPC would reduce lung injury in patients undergoing pulmonary resection.MethodsIn a randomized, prospective, parallel, controlled trial, 216 patients undergoing elective thoracic pulmonary resection under one-lung ventilation with propofol-remifentanil anesthesia were randomized 1:1 to receive either limb RIPC or conventional lung resection (control). Three cycles of 5-min ischemia/5-min reperfusion induced by a blood pressure cuff served as RIPC stimulus. The primary outcome was PaO2/FIO2. Secondary outcomes included other pulmonary variables, the incidence of in-hospital complications, markers of oxidative stress, and inflammatory response.ResultsLimb RIPC significantly increased PaO2/FIO2 compared with control at 30 and 60 min after one-lung ventilation, 30 min after re-expansion, and 6 h after operation (238 ± 52 vs. 192 ± 67, P = 0.03; 223 ± 66 vs. 184 ± 64, P = 0.01; 385 ± 61 vs. 320 ± 79, P = 0.003; 388 ± 52 vs. 317 ± 46, P = 0.001, respectively). In comparison with control, it also significantly reduced serum levels of interleukin-6 and tumor necrosis factor-α at 6, 12, 24, and 48 h after operation and malondialdehyde levels at 60 min after one-lung ventilation and 30 min after re-expansion (all P < 0.01). The incidence of acute lung injury and the length of postoperative hospital stay were markedly reduced by limb RIPC compared with control (all P < 0.05).ConclusionLimb RIPC attenuates acute lung injury via improving intraoperative pulmonary oxygenation in patients without severe pulmonary disease after lung resection under propofol-remifentanil anesthesia.

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    Remote ischaemic preconditioning was induced using a BP cuff on one arm with three 5-min-ON / 5-min-OFF cycles before surgical start. Patients receiving RIPC before elective thoracotomy and pulmonary resection experienced less acute lung injury (indicated by PaO2/FiO2) and a 30% shorter hospital stay compared to those who did not receive RIPC.

    Daniel Jolley  Daniel Jolley
     
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