Published online Mar 27, 2014. doi: 10.5313/wja.v3.i1.105
Revised: September 28, 2013
Accepted: November 1, 2013
Published online: March 27, 2014
Processing time: 208 Days and 21.3 Hours
Lung injury can arise during or after anesthesia and can lead to a complicated postoperative course with great implications for the patient. Unfortunately, treatment of acute lung injury is at the moment mainly supportive and rates of recovery have not really improved in the recent years. In many cases, lung injury can be anticipated and preventive measures seem possible. This represents a unique challenge to the anesthesiologist, as some new opportunities to reduce the frequency and/or severity of lung injury seem now available. These chances may arise from the potency of preconditioning the lungs before the main injury, with smaller injurious insults. Although preconditioning began to be applicated first on the myocardium, experimental studies have shown potentially beneficial results also for the lungs. This review summarizes the main methods of lung preconditioning that have been tried in experimental studies in the literature and the main mechanisms that are perhaps involved. Emphasis is given in the two main methods of preconditioning that seem readily applicable in the clinical praxis, that is ischemic preconditioning, as well as preconditioning with volatile anesthetics. The few, but interesting clinical studies are also summarized and the future research points in this evolving field of anesthesia are stressed.
Core tip: Currently, the efficacy of lung preconditioning is tested in various experimental studies. The first clinical studies regarding remote ischemic preconditioning have appeared, with conflicting results. This review summarizes the scientific knowledge on this arising research field.