The effect of ischemic preconditioning on redox status during liver resections—randomized controlled trial

Abstract

Ischemic preconditioning--especially in patients with liver cirrhosis--is a suitable method to decrease the I-R injury of the liver.

Ischemic preconditioning ameliorates spinal cord ischemia-reperfusion injury by triggering autoregulation

“…[8][9][10][11][12][13][14] The underlying mechanism is not entirely clear, however. Possible mechanisms include upregulation of hypoxia-inducible factor-1 target genes, expression modulation of nitric oxide synthases, inhibition of apoptosis, activation of extracellular signal-regulated kinase, and expression of heat-shock protein, vascular endothelial growth factor, and brain-derived neurotrophic factor.…”

A network meta-analysis comparing perioperative outcomes of interventions aiming to decrease ischemia reperfusion injury during elective liver resection

“…Trials in the literature demonstrated the beneficial effects of ischemic preconditioning on liver resection surgery in patients with background healthy livers, as well as those with background cirrhotic or steatotic livers, by showing a decrease in postoperative liver enzymes which are markers for liver parenchymal injury 3,12,13,43,64 . Although liver parenchymal injury is associated with derangements in the liver function tests (LFTs), this network meta-analysis did not assess LFTs due to significant variation between the included trials in the way LFTs were assessed.…”

“…In some trials, ischemic preconditioning was performed with 10 minutes of vascular inflow occlusion and 10 minutes of reperfusion 3,12,13,49,53 , whereas in other trials ischemic preconditioning was performed with 5 minutes of vascular inflow occlusion and 5 minutes of reperfusion 36,43,44 . Furthermore, in some trials ischemic preconditioning was followed by vascular inflow occlusion 12,13,35,46,49 , whereas in other trials it was followed by selective hepatic vascular exclusion 8,9,53 .…”

“…Patients with cirrhotic or steatotic liver are more sensitive to IR injury than patients with normal liver 3,6 . Many interventions have been used to decrease IR injury 3,[7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] and previous standard pairwise meta-analyses comparing these interventions [23][24][25] were limited by the fact that indirect comparisons between interventions could not be performed. The aim of this network metaanalysis is to combine direct and indirect evidence across trials in order to compare perioperative outcomes of different interventions aimed at decreasing IR injury during elective hepatectomy.…”

“…IR injury results in elevated liver enzymes and increased postoperative morbidity [2][3][4][5][6] . Patients with cirrhotic or steatotic liver are more sensitive to IR injury than patients with normal liver 3,6 .…”