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Cardioprotection by remote ischaemic preconditioning.

S R Walsh1, T Tang, U Sadat

  • 1Cambridge Vascular Research Unit, Box 201, Level 7, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK. srwalsh@doctors.org.uk

British Journal of Anaesthesia
|October 2, 2007
PubMed
Summary
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Remote ischaemic preconditioning (RIPC) may reduce heart attacks after surgery. This technique, involving brief limb ischemia, shows promise for preventing perioperative myocardial injury and other complications.

Area of Science:

  • Cardiology
  • Anesthesiology
  • Physiology

Background:

  • Perioperative myocardial infarction is a major cause of death after non-cardiac surgery.
  • Beta-blockers can reduce risk but have side effects and contraindications.
  • Remote ischaemic preconditioning (RIPC) offers a potential alternative strategy.

Purpose of the Study:

  • To review the evidence for remote ischaemic preconditioning (RIPC) in reducing perioperative myocardial ischaemia.
  • To explore the potential mechanisms and clinical effectiveness of RIPC.

Main Methods:

  • Literature search of Medline and Pubmed databases for studies on RIPC.
  • Analysis of basic science experiments and preliminary human clinical trials.

Main Results:

Related Experiment Videos

  • RIPC, induced by brief lower limb ischaemia, significantly reduces myocardial injury in small human trials.
  • RIPC may also decrease other ischaemic complications associated with surgery and anaesthesia.
  • Potential mechanisms involve humoral and neural pathways, including adenosine and protein kinase C.

Conclusions:

  • RIPC shows promise as a simple, cost-effective method to reduce perioperative myocardial injury.
  • Further large-scale clinical trials are necessary to confirm its effect on mortality and morbidity before routine adoption.