The effect of remote ischaemic preconditioning on postoperative cardiac and inflammatory biomarkers in pancreatic surgery: a randomized controlled trial

Abstract

Background Cardiac and inflammatory biomarkers have been associated with adverse outcome after major abdominal surgery. This study investigated the effect of remote ischaemic preconditioning (RIPC) on perioperative concentrations of high-sensitive cardiac troponin (hs-cTn) T and interleukin (IL) 6. Methods Adult patients scheduled for elective pancreatic surgery between March 2017 and February 2019 were randomized to either three cycles of upper-limb ischaemia and reperfusion (each 5 min) or a sham procedure before surgery. The primary endpoint was the maximum postoperative hs-cTnT concentration within 48 h after surgery. Secondary endpoints were postoperative myocardial injury (PMI), defined as an absolute increase of hs-cTnT of at least 14 ng/l above baseline concentration, maximum concentration of IL-6 within 48 h after surgery and postoperative complications within 30 days of surgery. Results Of 99 eligible patients, 46 underwent RIPC and 46 a sham procedure. RIPC did not reduce the maximum hs-cTnT concentration after surgery (12.6 ng/l RIPC, 16.6 ng/l controls, P = 0.225), nor did it lessen the incidence of PMI (15/45 RIPC, 18/45 controls, P = 0.375). The maximum postoperative IL-6 concentration was 265 pg/ml after RIPC versus 385 pg/ml in controls ( P = 0.108). Postoperative complications occurred in 23 RIPC and 24 control patients respectively. Conclusions Remote ischaemic preconditioning did not reduce the maximum postoperative hs-cTnT concentration. Postoperative myocardial injury, IL-6 concentrations and postoperative complications were similar between RIPC patients and controls. Trial registration Clinicaltrials.gov identifier NCT03460938.

Effect of remote ischemic preconditioning on lung function after surgery under general anesthesia: a systematic review and meta-analysis

“…Regarding the anesthetic agents, 17 trials used propofol for the maintenance of general anesthesia 8 , 9 , 15 , 16 , 29 – 40 , whereas the other trials used volatile anesthesia or did not restrict/document the anesthetic agent. In most cases, RIPC was performed after the induction of general anesthesia or before the start of surgery 5 , 7 , 15 – 17 , 19 , 21 , 23 , 24 , 27 – 32 , 35 – 37 , 39 , 41 – 66 ; otherwise, it was performed before the start of cardiopulmonary bypass 4 , 8 , 13 , 20 , 67 or 12–48 h before surgery 18 , 22 , 25 , 26 , 34 . A tourniquet was placed almost equally on the upper or lower limb.…”

“…Several trials subsequently examined the lung protective effects of RIPC 12 – 14 . More recently, some studies reported the inhibitory effects of RIPC on inflammatory cytokines in patients undergoing major abdominal surgery 15 – 17 . The effect of RIPC on lung protective effect is needed to be clarified by a meta-analysis on updated data.…”

Effect of remote ischemic preconditioning on lung function after surgery under general anesthesia: A systematic review and meta-analysis

“…4b). The serum IL-6 level at 24 hours after surgery was reported in 13 trials, 4,9,12,21,22,34,36,38,55,56,62,64,65 which did not show statistical signi cance (SMD − 0.4, 95% CI -0.9 to 0.1, I 2 = 93%) (Fig. 4b).…”

The New Orientation of Postoperative Analgesia: Remote Ischemic Preconditioning

“…35 Not all patients treated with RIPC showed a reduction in inflammatory marker levels, and there was no significant difference in inflammatory mediator levels in the RIPC group compared with the control group during TKA, shoulder surgery, living kidney transplant, or pancreatic surgery. [36][37][38][39] The reasons for the differences in the above results may be as follows. First, the differences may be related to the choice of anesthesia.…”

“…13,36 When RIPC was applied to mice with spinal cord ischemia-reperfusion injury, motor function was restored and improved, and RIPC had an important protective effect on nerves. 41 Surgical tissue injury triggers activation of both proinflammatory and antiinflammatory pathways, and RIPC significantly reduces IL-6, IL-1β and TNF-α levels in lung resection and colon surgery, while no significant changes in inflammatory factor levels are observed in pancreatic and gallbladder surgery; 10,14,32,39 this may be related to the less extensive ischemia-reperfusion injury than that seen in lung and colon surgery.It may also be related to the small number of patients in these studies, and it is necessary for us to increase the research subjects and expand the scope of research to prove the inhibitory effect of RIPC on inflammatory mediators. Differences in the preconditioning time and intensity of RIPC may also affect the release of inflammatory mediators, which may be the reason why IL-1β and TNF-α levels did not decrease on the 7th day after colon surgery.…”