The role of propofol for remote ischaemic preconditioning in the setting of cardiac surgery – a Cochrane systematic review †

Editor—The concept of remote ischaemic preconditioning (RIPC) is an easy, readily available and inexpensive strategy to increase resistance to myocardial ischaemia/reperfusion injury. Within the past decade, RIPC has been translated from experimental studies with promising results to proof-of-principle randomized controlled trials (RCTs) in the setting of cardiac surgery. Despite some beneficial effects in terms of reduced myocardial injury as expressed by blood markers,¹ most RCTs failed to show a benefit of RIPC on short or long-term clinical outcome in patients undergoing cardiac surgery.²³ In this context, use of the i.v. anaesthetic propofol has been repeatedly discussed as potential confounding factor that significantly interferes and inhibits RIPC's cardioprotective effects.⁴⁵ We recently performed a Cochrane Systematic Review¹ to evaluate the benefits and harms of RIPC in patients undergoing coronary artery bypass grafting, with or without valve surgery. However, the potential influence of volatile anaesthetics compared with propofol anaesthesia was only part of a subgroup analysis and has not been fully evaluated yet. There is still a need to either confirm or exclude propofol as a confounding factor.

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