The effect of remote ischemic preconditioning on perioperative cardiac and renal functions in coronary artery bypass grafting

Remote ischemic preconditioning (RIPC) is one of the proposed methods for prevention of renal and cardiac complications that can be seen on coronary artery bypass grafting (CABG) because of affected organ and tissues perfusion during surgery. We aimed to investigate the effect of RIPC on cardiac markers, intraoperative or postoperative arrhythmias, inotropic requirements, renal function tests, urine output for every hour and for 24 hours, extubation time, length of intensive care unit stay and the total hospital stay who underwent CABG surgery in our study. Our study was conducted on 100 patients with ASA score II-III, over the age of 18 years, who underwent CABG (with or without valve surgery). The patients were divided into 2 groups as applied preconditioning [Group OK (Onkoşullama: preconditioning)] and not applied [Group K (Kontrol: control)]. In Group OK patients, the intervention consisted of 3 cycles of RIPC on the upper limb for 5 minutes alternated with 5 minutes of rest. Cuff was inflated up to 200 mmHg. The primary outcome was perioperative arrhythmias; the secondary outcomes were CK-MB, troponin I, blood urea, creatinine and GFR levels at 6, 12 and 24 hours after surgery, urine output, inotrop / vasoactive drug requirement, arterial blood gas (ABG) analysis, the lenght of mechanical ventilation requirement, intensive care unit stay and hospital stay. There was no difference in demographic data of the patients between the 2 groups. The frequency of postoperative arrhythmia was significantly lower (p=0,046) in Group OK. There were no significant differences in terms of cardiac markers (troponin, CK-MB) (p>0.05). Urea and creatinine values were significantly increased in Group K (p<0,05). 24-hour urine output has decreased significantly in Group K (p=0.04). Compared with Group K, the lenght of mechanical ventilation requirement was significantly shortened (p=0,01) and inotrop requirement was decreased (p<0,05) in Group OK. As a result, we observed that postoperative arrhythmias, inotrop requirement, lenght of mechanical ventilation requirement can be reduced by RIPC. Additionally we believe that, RIPC has a beneficial effect on preventing renal damage caused by cardiopulmonary bypass. Keywords: Remote ischemic preconditioning, coronary artery by-pass grafting, postoperative arrhythmia, cardiac effect, renal effect