Key result
Pharmacological preconditioning with sevoflurane and dexmedetomidine reduced cardiac enzyme elevation, inotropic support, and ICU stay compared to remote ischemic preconditioning.
Why the study?
Cardiopulmonary bypass causes multisystem injury, including ischemia-reperfusion injury and systemic inflammation, prompting evaluation of strategies to reduce CPB-induced cardiac injury in adult patients undergoing major aortic surgeries.
Does pharmacological preconditioning reduce cardiac injury compared to remote ischemic preconditioning in adult patients undergoing major aortic surgeries?
RCT (n=42)
Does pharmacological preconditioning reduce cardiac injury compared to remote ischemic preconditioning in adult patients undergoing major aortic surgeries?
Pharmacological preconditioning with sevoflurane and dexmedetomidine offers superior myocardial protection compared to remote ischemic preconditioning in patients undergoing major aortic surgeries.
Background: Cardiopulmonary bypass (CPB) remains an essential element of the surgical correction of most majorcardiovascular lesions. CPB is complicated by multisystem injury, the mechanisms of which include ischemia–reperfusion injury (IRI) and a detrimental systemic inflammatory response. Cardiac, pulmonary and neuronal injury and dysfunction remain important clinical problems after CPB. Aim of the study: The aim of this study was to compare and evaluate the effectiveness of remote ischemic preconditioning and pharmacological preconditioning in reducing cardiac injury inducedby cardiopulmonary bypass in adult patients undergoing major aortic surgeries. Patients and Methods: This study included (42) patients, divided into two groups 21 patients each, Group R: Remote Ischemic Preconditioning (cycles of ischemia and reperfusion of lower limb using blood pressure cuff) and Group P: pharmacological preconditioning (administration of sevoflurane and dexmedetomidine). Results: The current studyshowed postoperative lower elevation in CK total enzyme, CK MB enzyme and troponin I enzyme and decreased inotropic support(adrenaline infusion) requirements post-operatively along with shorter duration of postoperative intubation and postoperative ICU stay in group Pcompared to group R. Conclusion: Pharmacological preconditioning using sevoflurane and dexmedetomidine hasmyocardial protective effect after CPB in adult patients undergoing major aortic surgeries more than remote ischemic preconditioning as reflected by lower elevation in CK total enzyme, CK MB enzyme and troponin I enzyme and decreased inotropic support (adrenaline infusion) requirements postoperatively along with shorter duration of both postoperative intubation and postoperative ICU stay.
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Nasr et al. (2020) conducted an RCT in Major aortic surgeries requiring cardiopulmonary bypass (n=42). Pharmacological preconditioning (sevoflurane and dexmedetomidine) vs. Remote Ischemic Preconditioning was evaluated on Cardiac injury (CK total, CK MB, troponin I). Pharmacological preconditioning with sevoflurane and dexmedetomidine reduced cardiac enzyme elevation, inotropic support, and ICU stay compared to remote ischemic preconditioning.
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