Remote Ischemic Preconditioning in Patients Undergoing Acute Minor Abdominal Surgery
Remote Ischemic Preconditioning in Patients Undergoing Acute Minor Abdominal Surgery
This study examines if remote ischemic preconditioning in patients undergoing minor acute
 abdominal surgery (laparoscopic cholecystitis due to acute cholecystitis) is associated with
 a modulation of endothelial dysfunction. half of the patients will receive remote ischemic
 preconditioning prior to surgery, the other half will serve as controls.
Remote ischemic preconditioning (RIPC) consists of cycles of forearm or leg ischemia and
 reperfusion by the inflation of a blood-pressure cuff over the systemic blood pressure for
 brief periods. The procedure is simple, safe and with no clear side effects. In clinical
 studies covering acute cardiology RIPC has effectively reduced myocardial injury,
 postoperative cardiovascular complications and cardiac mortality. Recently, the effect of
 RIPC on attenuating ischemia-reperfusion injury has been investigated in non-cardiac surgery
 as well. The organ specific ischemia-reperfusion injury, systemic oxidative stress and
 inflammatory response were attenuated due to the intervention but a complete understanding of
 the underlying protective mechanisms of RIPC is however still lacking.

 Experimental and clinical studies have implicated that the stimulus of RIPC is transmitted
 from the preconditioned tissue to other tissues and organs by humoral, neural and systemic
 anti-inflammatory mediators. The humoral and neural pathway are thought to be dependent on
 endogen substances such as adenosine, bradykinin, nitrogen oxide (NO) and
 calcitonin-gene-related-peptide (CGRP).
Inclusion Criteria:

 -  Patients undergoing acute or subacute cholecystectomy due to acute cholecystitis with
 a maximum of 7 days of symptoms prior to surgery

 Exclusion Criteria:

 -  Not capable of giving informed consent after oral and written information

 -  Surgery within 30 days of study inclusion

 -  Conditions that prevent the performance of remote ischemic preconditioning on the
 upper extremity, e.g. fractures, paresis, lymphedema

 -  performance of concomitant endoscopic retrograde cholangiopancreatography (ERCP)
 during surgery

 -  synchronous pancreatitis

 -  synchronous cholangitis