title: Cardioprotective Effect of Extended Remote Ischemic Preconditioning in Patients Coronary Artery Bypass Grafting Undergoing: A Randomized Clinical Trial.
abstract: BACKGROUND
  The cardioprotective effect of ischemic preconditioning has been known for many years. Since the temporary ischemia in the heart may cause lethal cardiac effects, the idea of creating ischemia in organs far from the heart such as limbs was raised as remote ischemic preconditioning (RIPC). We hypothesized that the extension of RIPC has more cardioprotective effect in patients undergoing coronary artery bypass graft (CABG) surgeries.
  
  
  METHODS
  In this triple-blind randomized clinical trial study, 96 patients were randomly divided into 3 groups and two blood pressure cuffs were placed on both upper and lower extremities. In group A, only upper extremity cuff and in group B upper limb and lower limb cuff was inflated intermittently and group C was the control group. RIPC was induced with three 5-min cycles of cuff inflation about 100 mmHg over the initial systolic blood pressure before starting cardiopulmonary bypass. The primary endpoints were troponin I and creatine phosphokinase-myoglobin isoenzyme (CK-MB).
  
  
  RESULTS
  Six hours after the termination of CPB, there was a peak release of the troponin I level in all groups (group A=4.90 ng/ml, group B=4.40 ng/ml, and group C=4.50 ng/ml). There was a rise in plasma CK-MB in all groups postoperatively and there were not any significant differences in troponin I and CK-MB release between the three groups.
  
  
  CONCLUSIONS
  RIPC induced by upper and lower limb ischemia does not reduce postoperative myocardial enzyme elevation in adult patients undergoing CABG.
  
  
  BACKGROUND
  IRCT2012071710311N1.
authors.affiliation: Shiraz Anesthesiology and Critical Care Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Karami
authors.affiliation: Shiraz Anesthesiology and Critical Care Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Mohamad Bagher
authors.initials: MB
authors.lastname: Khosravi
authors.affiliation: Department of Cardiac Surgery, Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Masih
authors.initials: M
authors.lastname: Shafa
authors.affiliation: Shiraz Anesthesiology and Critical Care Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Simin
authors.initials: S
authors.lastname: Azemati
authors.affiliation: Shiraz Anesthesiology and Critical Care Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Saeed
authors.initials: S
authors.lastname: Khademi
authors.affiliation: Shiraz Anesthesiology and Critical Care Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Seyed Hedayatalla
authors.initials: SH
authors.lastname: Akhlagh
authors.affiliation: Shiraz Anesthesiology and Critical Care Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Behzad
authors.initials: B
authors.lastname: Maghsodi
keywords: Coronary artery bypass; Ischemic preconditioning; Troponin I