title: Limb remote ischemic preconditioning attenuates lung injury after pulmonary resection under propofol-remifentanil anesthesia: a randomized controlled study.
abstract: BACKGROUND
  Remote ischemic preconditioning (RIPC) may confer the protection in critical organs. The authors hypothesized that limb RIPC would reduce lung injury in patients undergoing pulmonary resection.
  
  
  METHODS
  In a randomized, prospective, parallel, controlled trial, 216 patients undergoing elective thoracic pulmonary resection under one-lung ventilation with propofol-remifentanil anesthesia were randomized 1:1 to receive either limb RIPC or conventional lung resection (control). Three cycles of 5-min ischemia/5-min reperfusion induced by a blood pressure cuff served as RIPC stimulus. The primary outcome was PaO2/FIO2. Secondary outcomes included other pulmonary variables, the incidence of in-hospital complications, markers of oxidative stress, and inflammatory response.
  
  
  RESULTS
  Limb RIPC significantly increased PaO2/FIO2 compared with control at 30 and 60 min after one-lung ventilation, 30 min after re-expansion, and 6 h after operation (238 ± 52 vs. 192 ± 67, P = 0.03; 223 ± 66 vs. 184 ± 64, P = 0.01; 385 ± 61 vs. 320 ± 79, P = 0.003; 388 ± 52 vs. 317 ± 46, P = 0.001, respectively). In comparison with control, it also significantly reduced serum levels of interleukin-6 and tumor necrosis factor-α at 6, 12, 24, and 48 h after operation and malondialdehyde levels at 60 min after one-lung ventilation and 30 min after re-expansion (all P < 0.01). The incidence of acute lung injury and the length of postoperative hospital stay were markedly reduced by limb RIPC compared with control (all P < 0.05).
  
  
  CONCLUSIONS
  Limb RIPC attenuates acute lung injury via improving intraoperative pulmonary oxygenation in patients without severe pulmonary disease after lung resection under propofol-remifentanil anesthesia.
authors.affiliation: From the Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Cai
authors.initials: C
authors.lastname: Li
authors.forename: Miao
authors.initials: M
authors.lastname: Xu
authors.forename: Yan
authors.initials: Y
authors.lastname: Wu
authors.forename: Yun-Sheng
authors.initials: YS
authors.lastname: Li
authors.forename: Wen-Qi
authors.initials: WQ
authors.lastname: Huang
authors.forename: Ke-Xuan
authors.initials: KX
authors.lastname: Liu
mesh_terms: D055371:Acute Lung Injury / Q000517:prevention & control*; D000368:Aged; D000704:Analysis of Variance; D000771:Anesthesia, Intravenous / Q000379:methods*; D018686:Anesthetics, Intravenous; D002289:Carcinoma, Non-Small-Cell Lung / Q000601:surgery; D016207:Cytokines / Q000378:metabolism; D005260:Female; D006801:Humans; D007249:Inflammation / Q000378:metabolism / Q000473:pathology; D019194:Ischemic Preconditioning / Q000379:methods*; D008168:Lung / Q000601:surgery*; D008175:Lung Neoplasms / Q000601:surgery; D008297:Male; D008315:Malondialdehyde / Q000378:metabolism; D008875:Middle Aged; D018384:Oxidative Stress / Q000502:physiology; D010149:Postoperative Pain / Q000453:epidemiology; D010880:Piperidines; D015742:Propofol; D011446:Prospective Studies; D000077208:Remifentanil; D012129:Respiratory Function Tests; D018401:Sample Size; D016896:Treatment Outcome
chemical_list: D018686:Anesthetics, Intravenous; D016207:Cytokines; D010880:Piperidines; D008315:Malondialdehyde; D000077208:Remifentanil; D015742:Propofol