1. Introduction
Endothelial dysfunction, inflammation, ischaemia
ACUTE CHOLECYSTITIS, VASODILATION, DISEASE PROGRESSION, HYPERAEMIA, ENDOTHELIAL DYSFUNCTION, INFLAMMATION, CARDIOVASCULAR MORBIDITY, EVENTS, ISCHAEMIA, ENDOTHELIAL DYSFUNCTION
Endothelial dysfunction result from inflammation and excessive production of reactive oxygen species as part of the surgical stress response. Remote ischemic preconditioning (RIPC) potentially exerts anti-oxidative and anti-inflammatory properties, which might stabilise the endothelial function after non-cardiac surgery. This was a single centre randomised clinical trial including 60 patients undergoing sub-acute laparoscopic cholecystectomy due to acute cholecystitis. Patients were randomised to RIPC or control. The RIPC procedure consisted of four cycles of five minutes of ischaemia and reperfusion of one upper extremity. Endothelial function was assessed as the reactive hyperaemia index (RHI) and circulating biomarkers of nitric oxide (NO) bioavailability (L-arginine, asymmetric dimethylarginine (ADMA), L-arginine/ADMA ratio, tetra- and dihydrobiopterin (BHMore than 200 million adults undergo major non-cardiac surgery every year and the numbers are increasing [A healthy endothelium regulates vascular tone, blood fluidity, inflammatory processes, and controls coagulation, while endothelial dysfunction is associated with unfavourable vascular changes, such as loss of endothelium-dependent vasodilation and adoption of a pro-thrombotic endothelial cell phenotype, which are induced by pro-inflammatory processes [Endothelial dysfunction and its severity are associated with cardiovascular morbidity. Several studies imply that both coronary and peripheral endothelial dysfunction predict disease progression and cardiovascular events [Remote ischemic preconditioning (RIPC) is a procedure with short episodes of ischaemia and reperfusion applied to a limb. This non-invasive procedure might possess systemic anti-inflammatory and anti-oxidative properties when introduced prior to non-cardiac surgery [