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Li J, Wang X, Liu W, Wen S, Li X. Remote ischemic preconditioning and clinical outcomes after pediatric cardiac surgery: a systematic review and meta-analysis. BMC Anesthesiol 2023; 23:105. [PMID: 37005591 PMCID: PMC10067320 DOI: 10.1186/s12871-023-02064-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/22/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND The benefit of remote ischemia preconditioning (RIPreC) in pediatric cardiac surgery is unclear. The objective of this systematic review and meta-analysis was to examine the effectiveness of RIPreC in reducing the duration of mechanical ventilation and intensive care unit (ICU) length of stay after pediatric cardiac surgery. METHODS We searched PubMed, EMBASE and the Cochrane Library from inception to December 31, 2022. Randomized controlled trials comparing RIPreC versus control in children undergoing cardiac surgery were included. The risk of bias of included studies was assessed using the Risk of Bias 2 (RoB 2) tool. The outcomes of interest were postoperative duration of mechanical ventilation and ICU length of stay. We conducted random-effects meta-analysis to calculate weighted mean difference (WMD) with 95% confidence interval (CI) for the outcomes of interest. We performed sensitivity analysis to examine the influence of intraoperative propofol use. RESULTS Thirteen trials enrolling 1,352 children were included. Meta-analyses of all trials showed that RIPreC did not reduce postoperative duration of mechanical ventilation (WMD -5.35 h, 95% CI -12.12-1.42) but reduced postoperative ICU length of stay (WMD -11.48 h, 95% CI -20.96- -2.01). When only trials using propofol-free anesthesia were included, both mechanical ventilation duration (WMD -2.16 h, 95% CI -3.87- -0.45) and ICU length of stay (WMD -7.41 h, 95% CI -14.77- -0.05) were reduced by RIPreC. The overall quality of evidence was moderate to low. CONCLUSIONS The effects of RIPreC on clinical outcomes after pediatric cardiac surgery were inconsistent, but both postoperative mechanical ventilation duration and ICU length of stay were reduced in the subgroup of children not exposed to propofol. These results suggested a possible interaction effect of propofol. More studies with adequate sample size and without intraoperative propofol use are needed to define the role of RIPreC in pediatric cardiac surgery.
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Affiliation(s)
- Jianwen Li
- Departments of Anesthesiology, DongGuan SongShan Lake Tungwah Hospital, DongGuan, China
| | - Xiwen Wang
- Departments of Anesthesiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Wengui Liu
- Departments of Anesthesiology, DongGuan SongShan Lake Tungwah Hospital, DongGuan, China
| | - Shihong Wen
- Departments of Anesthesiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
| | - Xueping Li
- Departments of Anesthesiology, DongGuan SongShan Lake Tungwah Hospital, DongGuan, China.
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Yang X, Tian C, Gao Y, Yang L, Wu Y, Zhang N. Effect of remote ischemic preconditioning in patients undergoing laparoscopic colorectal cancer surgery: a randomized controlled trial. Scand J Gastroenterol 2022; 58:634-642. [PMID: 36469647 DOI: 10.1080/00365521.2022.2153344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND Remote ischemic preconditioning (RIPC) is reported to reduce ischemia-reperfusion injury (IRI) in many vital organs by inhibiting a systemic inflammatory response. Inflammation also plays an essential role in the pathophysiology of prolonged post-operative ileus (PPOI) in patients undergoing colorectal cancer (CRC) surgery. However, the role of RIPC is unclear in reducing the incidence of PPOI in patients undergoing CRC surgery. METHODS This was a prospective, randomized trial of RIPC vs. placebo-controlled in patients undergoing elective laparoscopic CRC surgery. Eighty patients were randomized to either a RIPC group or a control group (40 per arm), with computer-generated randomization. The aim was to determine whether RIPC improved the recovery of gut function. The primary outcomes assessed were time to gastrointestinal tolerance and incidence of PPOI. RESULTS Median time to stool of the RIPC group was significantly lower than that of the control group [RIPC vs. control, 4.0 (3.0, 6.0) vs. 5.0 (4.0, 7.8) days, p = 0.027]. Median time to gastrointestinal tolerance and incidence of PPOI in the RIPC group were lower than the control group; however, there were no statistical differences between the two groups [RIPC vs. control: 5.0 (3.0, 7.0) vs. 6.0 (4.0, 8.8) days, p = 0.178; 15 vs. 30%, p = 0.108]. CONCLUSION RIPC could shorten the median time to stool in patients undergoing laparoscopic CRC surgery, but did not improve the overall recovery time of gut function or reduce the incidence of PPOI. REGISTRATION NUMBER ChiCTR2100043313 (http://www.chictr.org.cn).Key pointsQuestion: In patients undergoing laparoscopic CRC surgery, does RIPC improve time to the overall recovery of gut function and reduce the incidence of PPOI?Findings: In this randomized clinical trial that included 80 patients undergoing elective laparoscopic CRC surgery, no significant difference was found between the RIPC group and the control group concerning median time to gastrointestinal tolerance and incidence of PPOI.Meaning: RIPC did not improve the time for overall recovery of gut function or reduce the incidence of PPOI in patients undergoing laparoscopic CRC surgery.
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Affiliation(s)
- Xiuming Yang
- Department of Anesthesiology and Perioperative Medicine, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Chun Tian
- Department of Anesthesiology and Perioperative Medicine, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Yuansong Gao
- Department of Anesthesiology and Perioperative Medicine, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Liu Yang
- Department of Anesthesiology and Perioperative Medicine, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - You Wu
- Department of Anesthesiology and Perioperative Medicine, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Na Zhang
- Department of Anesthesiology and Perioperative Medicine, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
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Effect of Remote Ischemic Preconditioning on the Incidence of Contrast Induced Nephropathy in Patients Undergoing Evar (Ripc-Evar Study). Ann Vasc Surg 2022; 86:338-348. [PMID: 35717008 DOI: 10.1016/j.avsg.2022.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 04/26/2022] [Accepted: 05/08/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Contrast induced nephropathy (CIN) is a major inconvenience in the use of iodinated contrast media (ICM) and it is associated with a significant increase in morbidity and mortality and cost of hospitalization. Remote ischemic preconditioning (RIPC) is a non-invasive and cost-effective tissue protection technique that has showed beneficial in decreasing renal insult in patients receiving intravascular contrast. AIM The primary outcome of this study is to evaluate the impact of RIPC on the incidence of CIN in patients undergoing endovascular aneurysm repair. MATERIAL AND METHODS Patients suffering from aortic aneurysm were recruited prior to the administration of iodinated contrast media. Randomization was used to assign patients into the control/RIPC groups. Biochemical parameters determined renal function before and after surgery in immediate (24-72 hours) and at 30 days' follow-up. RESULTS Of the 120 patients included in the study, 98,3% were male. Mean age was 73 years (range 56-87). Diabetes and chronic renal failure (considering eGFR<60) was present prior to administration of ICM in 29,16% and 38,33% respectively. RIPC was applied in 50% (n=60) of the patients. A total of 24,17% developed CIN regardless of fluid therapy, RIPC and other protective strategies. RIPC did not influence outcome in terms of incidence on CIN, serum creatinine, urea, estimated glomerular filtration (eGFR) or microalbuminuria in immediate postoperative period. However, the group of RIPC patients showed a statistically significant benefit in renal function in terms of serum creatinine (1,46 ± 0,3 vs 1,03 ± 0,5; p<0,001), urea (61,06 ± 27,5mg/dl vs 43,78 ± 12,9mg/dl; p=0,003) and an increase in eGFR (56,37 ± 23,4ml/min/1.73m2vs 72,85 ± 17,7ml/min/1.73m2; p=0,004) at 30 days follow-up. CONCLUSIONS RIPC seems to be a reasonable, effective and low-cost technique to alleviate effects of ICM on the renal parenchyma in EVAR procedures during short-term postoperative period.
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Park E, McCutcheon V, Telliyan T, Liu E, Eisen R, Kinio A, Tavakkoli J, Baker AJ. Remote ischemic conditioning improves outcome independent of anesthetic effects following shockwave-induced traumatic brain injury. IBRO Rep 2020; 8:18-27. [PMID: 31909289 PMCID: PMC6939039 DOI: 10.1016/j.ibror.2019.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 12/06/2019] [Indexed: 12/21/2022] Open
Abstract
Traumatic brain injury due to primary blast exposure is a major cause of ongoing neurological and psychological impairment in soldiers and civilians. Animal and human evidence suggests that low-level blast exposure is capable of inducing white matter injury and behavioural deficits. There are currently no effective therapies to treat the underlying suspected pathophysiology of low-level primary blast or concussion. Remote ischemic conditioning (RIC) has been shown to have cardiac, renal and neuro-protective effects in response to brief cycles of ischemia. Here we examined the effects of RIC in two models of blast injury. We used a model of low-level primary blast in rats to evaluate the effects of RIC neurofilament expression. We subsequently used a model of traumatic brain injury in adult zebrafish using pulsed high intensity focused ultrasound (pHIFU) to evaluate the effects of RIC on behavioural outcome and apoptosis in a post-traumatic setting. In blast exposed rats, RIC pretreatment modulated NF200 expression suggesting an innate biological buffering effect. In zebrafish, behavioural deficits and apoptosis due to pHIFU-induced brain injury were reduced following administration of serum derived from RIC rats. The results in the zebrafish model demonstrate the humoral effects of RIC independent of anesthetic effects that were observed in the rat model of injury. Our results indicate that RIC is effective in improving outcome following modeled brain trauma in pre- and post-injury paradigms. The results suggest a potential role for innate biological systems in the protection against pathophysiological processes associated with impairment following shockwave induced trauma.
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Affiliation(s)
- Eugene Park
- Keenan Research Centre in the Li Ka Shing Knowledge Institute at St. Michael's Hospital, Canada
| | - Victoria McCutcheon
- Keenan Research Centre in the Li Ka Shing Knowledge Institute at St. Michael's Hospital, Canada.,Institute of Medical Sciences, University of Toronto, Canada
| | - Tamar Telliyan
- Keenan Research Centre in the Li Ka Shing Knowledge Institute at St. Michael's Hospital, Canada
| | - Elaine Liu
- Keenan Research Centre in the Li Ka Shing Knowledge Institute at St. Michael's Hospital, Canada
| | - Rebecca Eisen
- Keenan Research Centre in the Li Ka Shing Knowledge Institute at St. Michael's Hospital, Canada
| | - Anna Kinio
- Keenan Research Centre in the Li Ka Shing Knowledge Institute at St. Michael's Hospital, Canada
| | - Jahan Tavakkoli
- Keenan Research Centre in the Li Ka Shing Knowledge Institute at St. Michael's Hospital, Canada.,Department of Physics, Ryerson University, Canada
| | - Andrew J Baker
- Keenan Research Centre in the Li Ka Shing Knowledge Institute at St. Michael's Hospital, Canada.,Institute of Medical Sciences, University of Toronto, Canada.,Departments of Anesthesia & Surgery, University of Toronto, Canada
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Cho YJ, Kim WH. Perioperative Cardioprotection by Remote Ischemic Conditioning. Int J Mol Sci 2019; 20:ijms20194839. [PMID: 31569468 PMCID: PMC6801656 DOI: 10.3390/ijms20194839] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 09/11/2019] [Accepted: 09/27/2019] [Indexed: 12/24/2022] Open
Abstract
Remote ischemic conditioning has been investigated for cardioprotection to attenuate myocardial ischemia/reperfusion injury. In this review, we provide a comprehensive overview of the current knowledge of the signal transduction pathways of remote ischemic conditioning according to three stages: Remote stimulus from source organ; protective signal transfer through neuronal and humoral factors; and target organ response, including myocardial response and coronary vascular response. The neuronal and humoral factors interact on three levels, including stimulus, systemic, and target levels. Subsequently, we reviewed the clinical studies evaluating the cardioprotective effect of remote ischemic conditioning. While clinical studies of percutaneous coronary intervention showed relatively consistent protective effects, the majority of multicenter studies of cardiac surgery reported neutral results although there have been several promising initial trials. Failure to translate the protective effects of remote ischemic conditioning into cardiac surgery may be due to the multifactorial etiology of myocardial injury, potential confounding factors of patient age, comorbidities including diabetes, concomitant medications, and the coadministered cardioprotective general anesthetic agents. Given the complexity of signal transfer pathways and confounding factors, further studies should evaluate the multitarget strategies with optimal measures of composite outcomes.
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Affiliation(s)
- Youn Joung Cho
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea.
| | - Won Ho Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea.
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Cho YJ, Nam K, Kim TK, Choi SW, Kim SJ, Hausenloy DJ, Jeon Y. Sevoflurane, Propofol and Carvedilol Block Myocardial Protection by Limb Remote Ischemic Preconditioning. Int J Mol Sci 2019; 20:ijms20020269. [PMID: 30641885 PMCID: PMC6359553 DOI: 10.3390/ijms20020269] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/04/2019] [Accepted: 01/08/2019] [Indexed: 01/27/2023] Open
Abstract
The effects of remote ischemic preconditioning (RIPC) in cardiac surgery have been inconsistent. We investigated whether anesthesia or beta-blockers interfere with RIPC cardioprotection. Fifty patients undergoing cardiac surgery were randomized to receive limb RIPC (four cycles of 5-min of upper arm cuff inflation/deflation) in the awake state (no-anesthesia; n = 17), or under sevoflurane (n = 17) or propofol (n = 16) anesthesia. In a separate crossover study, 11 healthy volunteers received either carvedilol or no medication prior to RIPC. Plasma dialysates were obtained and perfused through an isolated male Sprague⁻Dawley rat heart subjected to 30-min ischemia/60-min reperfusion, following which myocardial infarct (MI) size was determined. In the cardiac surgery study, pre-RIPC MI sizes were similar among the groups (39.7 ± 4.5% no-anesthesia, 38.9 ± 5.3% sevoflurane, and 38.6 ± 3.6% propofol). However, post-RIPC MI size was reduced in the no-anesthesia group (27.5 ± 8.0%; p < 0.001), but not in the anesthesia groups (35.7 ± 6.9% sevoflurane and 35.8 ± 5.8% propofol). In the healthy volunteer study, there was a reduction in MI size with RIPC in the no-carvedilol group (41.7 ± 4.3% to 30.6 ± 8.5%; p < 0.0001), but not in the carvedilol group (41.0 ± 4.0% to 39.6 ± 5.6%; p = 0.452). We found that the cardioprotective effects of limb RIPC were abolished under propofol or sevoflurane anesthesia and in the presence of carvedilol therapy.
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Affiliation(s)
- Youn Joung Cho
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea.
| | - Karam Nam
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea.
| | - Tae Kyong Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea.
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul 07061, Korea.
| | - Seong Woo Choi
- Department of Physiology, Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul 03080, Korea.
- Department of Stem Cell Biology, School of Medicine, Konkuk University, Seoul 05029, Korea.
| | - Sung Joon Kim
- Department of Physiology, Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul 03080, Korea.
| | - Derek J Hausenloy
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore 169857, Singapore.
- Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College of London, London WC1E 6HX, UK.
- Tecnologico de Monterrey, Centro de Biotecnologica-FEMSA, Nuevo Leon 64849, Mexico.
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
- The National Institute of Health Research, University College London Hospitals, Biomedical Research Centre, London W1T 7DN, UK.
- National Heart Research Institute Singapore, National Heart Centre, Singapore 169609, Singapore.
| | - Yunseok Jeon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea.
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