الفهرس 
Introduction and aim of the work
Mechanism of ischemic Pre-conditioningOnly 14 pages are availabe for public view
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Abstract
There is no question that myocardial ischemia has profound and deleterious effects on metabolism and contractile performance of the heart and ultimately;onmyocyte viability.
RIPC We can do it by 5 minute inflation of blood pressure cuff above systolic pressure above 200mmHgb 3timesit Release 5 minute ;repeat its easy ;non invasive ;simple costless. And we use by Sevoflurane as a pharmacologic preconditioner.
Method
Thirty patients undergoing open heart surgery were randomly divided into two groups group A (15 patients).anaesthetized by Sevoflurane as a pharmacologic preconditioner. and group B (15patient) ischemic preconditioning will be done after induction and before cardiopulmonary bypass by inflation the cuff of blood pressure above 200mmhg in the lower limb every 5 min for 3cycles , with maintenance of anesthesia by isoflurane .assessment parameter include demographic and clinical datainclude (patient’s name ,age ,gender, weight ,height ,type of surgery and American society of anesthesiology (ASA) physical status) .
Preoperative Cardiac data including :(ECG ,Ehocardiographic data, medications.
Laboratory investigation:( Arterial blood gas analysis &Blood sugar level : preoperative and postoperative / 6 hours up to 2 days ; Complete blood picture , kidney function preoperative , 1st and 2nd postoperative day; Intraoperative Vital signsincludedTotal bypass time, Cross clamping time,Operative time).
Postoperative Assessment parameters:
Duration of Vasopressor Inotropic Agent.Highest inotropic score during the first 24 hours after cardiac surgery.
The inotropic score is calculated as follows Wernowsky IS = Dopamine dose (μg/kg/min) + Dobutamine dose (μg/kg/min) +100 × epinephrine dose (μg/kg/min)(4)
Result
There were no significant differences between two groups in inotropic score and hospital stay ;renal ;respiratory and inflammatory protection after cardiopulmonary bypass.
Conclusion
Both ischemic and pharmacological cardiac preconditioning could offer some sort of cardiac protection reflected upon inotropic score; pulmonary; renal and inflammatory functions. Ischemic preconditioning is superior to the other techniques at limiting myocardial necrosis during CABG. Pharmacological preconditioning may offer some benefit but this was not statistically.
Limitation
There is a need for larger sample size; and comparison of each type of preconditioning to control group of patients undergoing cardiac surgery.