If you wish to respond to a paper or other item already published in the BJA, please go to the abstract/full text version of that item and click on the link "E-Letters: Submit a response to the article".
Electronic Letters to:
|
|
E-letters: Electronic letters published:
-
![[Read E-letter]](/icons/misc/sectionDOWN.gif)
Remote ischaemic preconditioning
- Matt Thomas (9 July 2009)
|
|
|||
|
Matt Thomas, Senior Registrar Royal North Shore Hospital, Sydney
Send letter to journal:
|
Dear Sir, Dr Frassdorf and colleagues (1) have written an excellent review of anaesthetic-induced cardioprotection and its application to clinical practice. However they have not considered remote ischaemic preconditioning (RICP), a technique previously reviewed in this journal (2), that could, or perhaps even should, be a part of a comprehensive 'cardioprotective anaesthetic protocol'. The basis of RIPC is the protection against ischaemia in the target tissue (usually myocardium) conferred by brief periods of ischaemia in a distant tissue (e.g. foremarm ischaemia produced using an inflated blood pressure cuff). While large clinical trials with hard outcomes are lacking, there is evidence of better surrogate outcomes in cardiac surgery (reduced troponin relase after CABG)(3) and vascular surgery (reduced troponin release and myocardial infarction after aortic aneurysm repair)(4). In elective percutaneous coronary intervention RICP is associated with reduced cardiac and cerebral events in the subsequent 6 months (5). The technique appears worthy of further consideration, especially given its simplicity and relative lack of adverse effects. Whether there is clinically meaningful interaction between pharmacological and physical methods of preconditioning is unknown. When trials of preconditioning protocols are designed RICP should be included along with pharmacological means. 1. Frassdorf J, De Hert S, Schlack W. Anaesthesia and myocardial ischaemia-reperfusion injury. British Journal of Anaesthesia 2009; 103: 89 -98. 2. Walsh S, Tang T, Sadat U, Dutka D, Gaunt M. Cardioprotection by remote ischaemic preconditioning. British Journal of Anaesthesia 2007; 99: 611- 616. 3. Hausenloy D, Mwamure P, Venugopal V et al. Effect of remote ischaemic preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery: a randomised controlled trial. Lancet 2007; 370: 575-579. 4. Ali Z, Callaghan C, Lim E et al. Remote ischaemic preconditioning reduces myocardial and renal injury after elective abdominal aortic aneurysm repair: a randomised controlled trial. Circulation 2007; 116 (Suppl): I98-I105. 5. Hoole S, Heck P, Sharples L et al. Cardiac remote ischaemic preconditioning in coronary stenting (CRISP) study: a prospective randomized controlled trial. Circulation 2009; 119: 820-827. Conflict of Interest:None declared |
|||