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

Purpose: Remote ischemic preconditioning (rIPC) is a novel technique in which brief episodes of ischemia and reperfusion in one organ confer protection 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, it remains unclear whether simultaneous application of these techniques could result in complementary, additive, synergistic, or adverse effects. Methods: An adult rabbit heart Langendorff model of global 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 group underwent four cycles of 5-minute ischemia on the hind limb, each followed by 5 minutes of reperfusion. The APC group received 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 global ischemia by >50% compared to the untreated control group (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.