Surgical implications of ischemic preconditioning.

BACKGROUND: Ischemic preconditioning (IP) has emerged as a powerful experimental method of ameliorating ischemic injury in a variety of organs. This systematic review examines the surgical implications of this phenomenon. Data Source A MEDLINE search was conducted to identify laboratory and clinical studies investigating IP-induced protection in a variety of organ systems. Particular emphasis was placed on uncovering evidence for the use of IP in the surgical setting. DATA SYNTHESIS: Human clinical trials using IP have been successfully carried out in the fields of cardiac, hepatic, and pulmonary surgery. Epidemiologic data exist to support the existence of IP-induced neuroprotection in humans. Human skeletal muscle has been preconditioned experimentally, as have human proximal tubule (renal) cells. At present, there is no evidence for IP occurring in the human intestine, although animal studies attest to the possibility. Ischemic preconditioning appears to be effective even when applied to a site remote to the organ exposed to ischemia. However, these favorable effects are less evident in diabetic and elderly patients.
CONCLUSION: Ischemic preconditioning is safe for use in elective cardiac, hepatic, and pulmonary surgery. More studies with greater patient numbers need to be carried out in these areas to demonstrate the efficacy of IP in providing clinical benefit in terms of reducing morbidity and mortality. Although laboratory and experimental evidence is favorable, clinical studies using IP in orthopedic, vascular, reconstructive, transplantation, and gastrointestinal surgery are lacking.