Preconditioning and its clinical potential

Abstract

Preconditioning is emerging as a simple, safe and highly effective means of attenuating local and systemic effects of medical and surgical insult. Its enormous potential has not yet been harnessed and ongoing work will continue to bring it to the fore. This article covers the history, development and future clinical potential of preconditioning with particular regard to surgical insult.

The Role of Oxidative Stress Response Revealed in Preconditioning Heat Stimulation in Skeletal Muscle of Rats

“…The concentration of NO metabolites increased within minutes and de novo HSP-70 expression increased 16 h later. These findings are compatible with the concept of primary and secondary protective windows [3], and provide vital information for determining the appropriate time for clinical heat preconditioning. For surgical operations, such as flap transfers, heat preconditioning could be applied to the donor site 12 to 24 h before the procedure.…”

“…Preconditioning encompasses any sublethal stimulation-induced protection from subsequent critical injury. Previous studies have focused mainly on the ischemic preconditioning of the heart [3]. Magill et al reported various other prior noxious stimulations including hypoxia, hypothermia, heat stress, and pharmacologic agents [3].…”

“…Previous studies have focused mainly on the ischemic preconditioning of the heart [3]. Magill et al reported various other prior noxious stimulations including hypoxia, hypothermia, heat stress, and pharmacologic agents [3]. Additional studies have observed the induced-tolerance phenomenon in many other organs or tissues, such as the liver [4], kidney [5], lung, brain [6], and intestine [7].…”

“…The mechanisms of ischemic preconditioning in the heart involve an early protection phase, within 2 h of preconditioning, and a late protection phase (''second window of protection''), 24 to 72 h after preconditioning [3]. Nitric oxide (NO) and other reactive oxygen species (ROS) play vital roles in both phases [9], and de novo synthesis heat shock proteins (HSPs) are significantly involved in protection mechanisms in the late phase [8].…”