title: Remote ischemic preconditioning and outcome: shall we all have an intermittent tourniquet?
abstract: OBJECTIVE
  Although advancements in perioperative care have been made over the last decades, the perioperative outcome could not be improved adequately. Therefore, new therapeutic strategies are required to decrease morbidity and all-cause mortality in surgical patients. Remote ischemic preconditioning (RIPC), defined as brief and transient episodes of ischemia at a remote site before a subsequent injury of the target organ, is an adaptive response to protect for organ injury elicited by different stimuli. This review evaluates the current clinical evidence for RIPC as a potential tissue-protective strategy and discusses the underlying mechanism.
  
  
  RESULTS
  Several studies demonstrated the tissue-protective effect of RIPC in various organs, including the heart, brain, and kidney. However, the existence of controversial results may be explained by the fact that different study protocols were used and different patient populations were recruited.
  
  
  CONCLUSIONS
  RIPC may offer a novel inexpensive and noninvasive therapeutic strategy to alleviate organ injury in the perioperative period. However, adequately powered, large, multicenter clinical studies are necessary to accurately determine whether ischemic conditioning can improve the clinical outcomes of patients at risk for ischemia-reperfusion injury.
authors: Department of Anesthesiology, Intensive Care and Pain Medicine, University of Münster, Münster, Germany.
authors: Alexander
authors: A
authors: Zarbock
authors: Hugo
authors: H
authors: Van Aken
authors: Christoph
authors: C
authors: Schmidt
mesh_terms: D000758:Anesthesia / Q000009:adverse effects / Q000379:methods; D000818:Animals; D006801:Humans; D019194:Ischemic Preconditioning / Q000379:methods*; D019990:Perioperative Care / Q000379:methods*; D015398:Signal Transduction; D014111:Tourniquets; D016896:Treatment Outcome