The effect of remote ischaemic preconditioning on endothelial function after hip fracture surgery

Abstract

The endothelium has a central regulative role in maintaining vascular homeostasis. 1 Besides controlling the vascular tone, it has an anti-inflammatory, anti-thrombotic and anti-fibrinolytic systemic effect. 1,2 Clinical studies in non-cardiac surgery have shown that surgery causes a state of acute endothelial dysfunction lasting for days after the surgical procedure. 3,4 The extent of endothelial dysfunction after surgery seems to be influenced by perioperative factors such as type of surgery, anaesthetics and pain. 3,[5][6][7] While pre-operative endothelial dysfunction has been associated with the risk of developing perioperative major adverse cardiovascular events 8-10 the clinical consequences of endothelial dysfunction in the perioperative period remain to be established. Endothelial dysfunction early after surgery may play a role in the pathophysiology of myocardial injury. 11 Remote ischaemic preconditioning (RIPC) is a non-invasive procedure with reversible episodes of ischaemia and reperfusion

Effect of Remote Ischemic Conditioning on Bleeding Complications in Surgery: A Systematic Review and Meta-Analysis

“…In addition, seven trials reporting continuous bleeding data as median with range or interquartile range were excluded. [20][21][22][23][24][25][26] Accordingly, 32 randomized controlled trials reporting one or more bleeding outcomes were included (►Fig. 1), with an aggregate of 3,804 patients (1,897 randomized to RIC and 1,907 to control).…”

Effect of Remote Ischaemic Preconditioning on Perioperative Endothelial Dysfunction in Non-Cardiac Surgery: A Randomised Clinical Trial

“…The effect of RIPC on RHI has been investigated in one other trial with patients undergoing subacute hip fracture surgery, where endothelial function was assessed as a point-assessment of RHI on postoperative day one. The study found no significant effect of RIPC on postoperative RHI [ 43 ]. Apart from the RIPC procedure being initialised in the operating room just prior to surgery, the definition, duration, and number of cycles were identical to our RIPC intervention [ 43 ].…”

“…The study found no significant effect of RIPC on postoperative RHI [ 43 ]. Apart from the RIPC procedure being initialised in the operating room just prior to surgery, the definition, duration, and number of cycles were identical to our RIPC intervention [ 43 ]. While no other studies, to our knowledge, have investigated the effect of RIPC on postoperative endothelial function in patients undergoing non-cardiac surgery, it has been investigated in patients with acute myocardial infarction prior to percutaneous coronary intervention with a significant effect lasting until one week after the intervention [ 44 ].…”

“…The trial was exploratory, and no sample size calculation was performed. It has been demonstrated that RHI measurements and data vary depending on the type of surgery and the population investigated [ 16 , 43 , 54 , 55 ]. Nonetheless, the lack of sample size calculation introduces the risk of type II errors.…”