J Anesth Perioper Med. 2015;2(1):48-51. https://doi.org/10.24015/ebcmed.japm.2015.0008
From the Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Correspondence to Dr. Fu-Shan Xue at firstname.lastname@example.org.
EBCMED ID: ebcmed.japm.2015.0008 DOI: 10.24015/ebcmed.japm.2015.0008
In conclusion, in a prospective, randomized, and controlled clinical trial, Li and colleagues challenge the hypothesis whether limb remote ischemic preconditioning can produce a beneficial effect on post-thoracotomy ALI, and show that intermittent upper limb ischemia as a remote ischemic preconditioning stimulus improves intraoperative pulmonary function after lung resection in patients without severe pulmonary disease. Undoubtedly, this study further enriches our knowledge regarding the effect of limb remote ischemic preconditioning on perioperative organ injury. Furthermore, their findings might change the current practice of perioperative anagement of thoracic surgical patients. However, it must be emphasized there are some limitations in the study design and conflicting results regarding the lung protection of remote ischemic preconditioning in available literatures. Before remote ischemic preconditioning can be recommended as a routine clinical practice to attenuate postthoracotomy ALI, we believe there is still a long way to go. Specially, it needs to address some crucial problems about use of the remote ischemic preconditioning. For example, what is the extent of lung protection by remote ischemic preconditioning? What is the best time to perform remote ischemic preconditioning before surgery? What are precise mechanisms of remote ischemic preconditioning against post-thoracotomy ALI? Can remote ischemic preconditioning be combined with other lung protective measures, for example pharmacological preconditioning or postconditioning? If combined, can a synergistic lung protection be obtained? Can favorable effect of remote ischemic preconditioning on postthoracotomy ALI be translated to postoperative mortality benefit? Evidently, future experimental and clinical trials are needed to answer these questions.
Declaration of Interests
All authors have no financial support and potential conflicts of interest for this work.
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