Effect of remote ischaemic preconditioning on ischaemicreperfusion injury in pulmonary hypertensive infants receiving ventricular septal defect repair

Abstract

BackgroundRemote ischaemic preconditioning (RIPC) can reduce ischaemicreperfusion injury in distant organs. The myocardial and pulmonary protective effect of RIPC in infants with pulmonary hypertension remains unclear. We conducted a randomized controlled trial to evaluate the effect of RIPC in infants receiving ventricular septal defect (VSD) repair. MethodsWe studied 55 infants with pulmonary hypertension undergoing VSD repair (RIPC group, n27; control group, n28). RIPC consisted of four 5 min cycles of lower limb ischaemia and reperfusion. Serum troponin I (TnI) concentrations were measured after induction of anaesthesia and at 1, 6, 12, and 24 h after surgery. Other clinical data such as inotropic score, lung compliance, alveolararterial oxygen gradient, oxygen index, mechanical ventilation time, and length of intensive care unit stay were also recorded at each interval. ResultsNo differences in patient or surgical characteristics were observed between the two groups. There were no significant differences in postoperative TnI levels according to time (P0.35) or the total amount of TnI release, expressed as the area under the curve over the 24 h after surgery [RIPC vs control: 207.6 (134.0) vs 274.6 (263.7) h ng ml-1, P0.24]. All other clinical data were also comparable. ConclusionsRIPC does not reduce the postoperative TnI release after VSD repair in infants with pulmonary hypertension. Additionally, it is difficult to find significant clinical benefits of RIPC in this population. The effect of RIPC varies according to clinical situation and patient condition. © The Author [2012]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved.