Remote Ischemic Preconditioning Decreases Oxidative Lung Damage After Pulmonary Lobectomy: A Single-Center Randomized, Double-Blind, Controlled Trial

Anesthesia and Analgesia
José García-de-la-AsunciónFrancisco Javier Belda

Abstract

During lobectomy in patients with lung cancer, the operated lung is often collapsed and hypoperfused. Ischemia/reperfusion injury may then occur when the lung is re-expanded. We hypothesized that remote ischemic preconditioning (RIPC) would decrease oxidative lung damage and improve gas exchange in the postoperative period. We conducted a single-center, randomized, double-blind trial in patients with nonsmall cell lung cancer undergoing elective lung lobectomy. Fifty-three patients were randomized to receive limb RIPC immediately after anesthesia induction (3 cycles: 5 minutes ischemia/5 minutes reperfusion induced by an ischemia cuff applied on the thigh) and/or control therapy without RIPC. Oxidative stress markers were measured in exhaled breath condensate (EBC) and arterial blood immediately after anesthesia induction and before RIPC and surgery (T0, baseline); during operated lung collapse, immediately before resuming two-lung ventilation (TLV) (T1); immediately after resuming TLV (T2); and 120 minutes after resuming TLV (T3). The primary outcome was 8-isoprostane levels in EBC at T1, T2, and T3. Secondary outcomes included the following: NO2+NO3, H2O2 levels, and pH in EBC and in blood (8-isoprostane, NO2+NO3) and pulmona...Continue Reading

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Citations

Jul 22, 2017·Anesthesia and Analgesia·Jonathan P Wanderer, Naveen Nathan
Aug 18, 2017·Anesthesia and Analgesia·Jonathan P Wanderer, Naveen Nathan
Aug 27, 2019·Annals of Vascular Surgery·José García-de-la-AsunciónMarina Soro
Sep 9, 2019·Respiratory Physiology & Neurobiology·Astrid BergmannThomas Hachenberg
Jan 7, 2021·American Journal of Physiology. Lung Cellular and Molecular Physiology·Anthony V IncognitoW Glen Pyle
May 18, 2020·The Journal of Thoracic and Cardiovascular Surgery·Akira MukaiKiyonobu Nishikawa

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