2.4. Intervention
ischaemia, diabetes
ISCHAEMIA, DIABETES
All patients received standard care according to local guidelines during their hospital stay, regardless of study allocation (standard regimen of (1) antibiotics: intra venous infusion with metronidazole 500 mg every eight hours and piperacillin/tazobactam 4 g every six hours; (2) analgetic: acetaminophen 1 g every six hours and Ibuprofen 400 mg every eight hours, morphine tablets 10 mg pro necessitate; (3) isotonic saline in case of discomfort during fasting prior to surgery (six hours for food and two hours for thin liquids prior to surgery) and (4) glucose–insulin–potassium intravenous infusion during fasting, according to local guidelines, if patient was diagnosed with diabetes). Patients in the RIPC group underwent four cycles of five minutes of ischaemia and five minutes of reperfusion of one upper extremity. The intervention was performed with an electronic tourniquet device (Tourniquet 4500 ECL; VBM Medizintechnik, Sulz am Neckar, Germany) placed on one upper arm with a cuff inflation of 200 mm Hg as a minimum. If a patient had a systolic blood pressure >185 mmHg, tourniquet inflation to a minimum of 15 mmHg above the patient’s systolic blood pressure was required. RIPC was performed less than four hours prior to surgery (knife-to-skin). A biphasic pattern of RIPC-protection has been suggested with an ‘early phase’ activated instantly, lasting about 4 h and peaking within that timespan [