Korean J Anesthesiol.  2013 Nov;65(5):418-424. 10.4097/kjae.2013.65.5.418.

Effect of remote ischemic preconditioning on cognitive function after off-pump coronary artery bypass graft: a pilot study

• Joung KW
• Rhim JH
• Chin JH
• Kim WJ
• Choi DK
• Lee EH
• Hahm KD
• Sim JY
• Choi IC

• KMID: 2299413
• DOI: http://doi.org/10.4097/kjae.2013.65.5.418

Abstract

BACKGROUND
Several studies have shown in animal models that remote ischemic preconditioning (rIPC) has a neuroprotective effect. However, a randomized controlled trial in human subjects to investigate the neuroprotective effect of rIPC after cardiac surgery has not yet been reported. Therefore, we performed this pilot study to determine whether rIPC reduced the occurrence of postoperative cognitive dysfunction in patients who underwent off-pump coronary artery bypass graft (OPCAB) surgery.
METHODS
Seventy patients who underwent OPCAB surgery were assigned to either the control or the rIPC group using a computer-generated randomization table. The application of rIPC consisted of four cycles of 5 min ischemia and 5 min reperfusion on an upper limb using a blood pressure cuff inflating 200 mmHg before coronary artery anastomosis. The cognitive function tests were performed one day before surgery and again on postoperative day 7. We defined postoperative cognitive dysfunction as decreased postoperative test values more than 20% of the baseline values in more than two of the six cognitive function tests that were performed.
RESULTS
In the cognitive function tests, there were no significant differences in the results obtained during the preoperative and postoperative periods for all tests and there were no mean differences observed in the preoperative and postoperative scores. The incidences of postoperative cognitive dysfunction in the control and rIPC groups were 28.6% (10 patients) and 31.4% (11 patients), respectively.
CONCLUSIONS
rIPC did not reduce the incidence of postoperative cognitive dysfunction after OPCAB surgery during the immediate postoperative period.

Keyword

Cognitive disorders; Neuroprotective effect; Off-pump coronary artery bypass

MeSH Terms

Blood Pressure
Coronary Artery Bypass, Off-Pump*
Coronary Vessels
Humans
Incidence
Ischemia
Ischemic Preconditioning*
Models, Animal
Neuroprotective Agents
Pilot Projects*
Postoperative Period
Random Allocation
Reperfusion
Thoracic Surgery
Transplants*
Upper Extremity
Neuroprotective Agents