Exploration of the interaction between remote ischemic preconditioning and anesthetic-induced preconditioning using sevoflurane in isolated per fused rabbit heart

Objectives: Remote ischemic preconditioning ( rIPC ) is a novel technique in which brief episodes of ischemia and reperfusion in one organ conferprotection against prolonged ischemia in a distant organ. In contrast, anesthetic-induced preconditioning ( APC ) utilizes volatile anesthetics to protect multiple organs from ischemia-reperfusion injury.Both methods are easily integrated into various clinical scenarios for cardioprotection.However, itremains unclearwhether simultaneous application of these techniques could result in complementary, additive, synergistic, or adverse effects. Methods: An adult rabbit heart Langendorff model of g lobal ischemia/reperfusion injury was used to compare the cardioprotective effect of rIPC and APC alone and in combination relative to untreated ( control ) hearts.The rIPC g roup underwent four cycles of 5-minute ischemia on the hind limb, each followed by 5 minutes of reperfusion.The APC g roupreceived 2.5 vol% sevoflurane for 20 minutes via a face mask, followed by a 20-minute washout period. Results: Both in vivo rIPC, induced by four 5-minute cycles of ischemia/reperfusion on the hind limb, and APC, administered as 2.5 vol% sevoflurane via a mask, significantly reduced the size of myocardial infarction following 30 minutes of g lobal ischemia by >50% compared to the untreated control g roup ( rIPC,12.1 +/- 1.7% ; APC, 13.5 +/- 2.1%; P<0.01 compared to control, 31.3 +/- 3.0%). However, no additional protective effect was observed when rIPC and APC were combined ( rIPC+APC, 14.4 +/- 3.3%). Conclusion: Although combining rIPC and APC did not provide additional protection, there was no inhibitory effect of one intervention on the other.