title: Effect of combined remote ischemic preconditioning and postconditioning on pulmonary function in valvular heart surgery.
abstract: BACKGROUND
  The aim of this study was to evaluate the lung-protective effect of combined remote ischemic preconditioning (RIPCpre) and postconditioning (RIPCpost) in patients undergoing complex valvular heart surgery.
  
  
  METHODS
  In this randomized, placebo-controlled, double-blind trial, 54 patients were assigned to an RIPCpre plus RIPCpost group or a control group (1:1). Patients in the RIPCpre plus RIPCpost group received three 10-min cycles of right-side lower-limb ischemia of 250 mm Hg at both 10 min after anesthetic induction and weaning from cardiopulmonary bypass. The primary end point was to compare postoperative Pao(2)/Fio(2). Secondary end points were to compare pulmonary variables, incidence of acute lung injury, and inflammatory cytokines.
  
  
  RESULTS
  In both groups, Pao(2)/Fio(2) at 24 h postoperation was significantly decreased compared with each corresponding baseline value. However, intergroup comparisons of pulmonary variables, including Pao(2)/Fio(2) and incidence of acute lung injury, revealed no significant differences. Serum levels of IL-6, IL-8, IL-10, and tumor necrosis factor-α were all significantly increased in both groups compared with each corresponding baseline value, without any significant intergroup differences. There were also no significant differences in transpulmonary gradient of IL-6, IL-10, and tumor necrosis factor-α between the groups.
  
  
  CONCLUSIONS
  RIPCpre plus RIPCpost as tested in this randomized controlled trial did not provide significant pulmonary benefit following complex valvular cardiac surgery.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Kyungpook National University Hospital, Daegu.
authors.forename: Jong-Chan
authors.initials: JC
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Jae-Kwang
authors.initials: JK
authors.lastname: Shim
authors.affiliation: Division of Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Sak
authors.initials: S
authors.lastname: Lee
authors.affiliation: Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea. Electronic address: ylkwak@yuhs.ac.
authors.forename: Young-Chul
authors.initials: YC
authors.lastname: Yoo
authors.affiliation: Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: So-Young
authors.initials: SY
authors.lastname: Yang
authors.affiliation: Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea; Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Young-Lan
authors.initials: YL
authors.lastname: Kwak
mesh_terms: D055371:Acute Lung Injury / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D000328:Adult; D000368:Aged; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D004311:Double-Blind Method; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D057775:Ischemic Postconditioning / Q000379:methods*; D019194:Ischemic Preconditioning / Q000379:methods*; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011659:Pulmonary Gas Exchange / Q000502:physiology; D012123:Pulmonary Ventilation / Q000502:physiology*; D015427:Reperfusion Injury / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control