Remote ischemic preconditioning on perioperative autonomic nervous system function and postoperative recovery in patients undergoing cholecystectomy

Background: Cholecystectomy often disrupts autonomic balance, impacting recovery. Remote ischemic preconditioning (RIPC) may enhance ANS function and protect organs, but its role in cholecystectomy is unclear.

Methods: In this randomized controlled trial, 80 patients aged 45 to 65 years, scheduled for elective laparoscopic cholecystectomy, were randomly assigned to either the RIPC group or the control group. The primary outcomes were mean arterial pressure (MAP), heart rate variability (HRV), and the low-frequency to high-frequency ratio (LF/HF) measured at various time points during the perioperative period. Secondary outcomes included liver and kidney function markers, postoperative hospital stay, and 30-day mortality rates.

Results: RIPC group significantly improved HRV compared to the control group at 5 minutes post-anesthesia induction (42.5 ± 9.8 ms vs. 36.4 ± 10.1 ms, P = 0.02) and at the end of surgery (44.8 ± 10.5 ms vs. 37.1 ± 9.3 ms, P = 0.01). The LF/HF ratio was significantly lower in the RIPC group at 30 minutes into surgery (1.25 ± 0.35 vs. 1.67 ± 0.42, P = 0.04) and at the end of surgery (1.19 ± 0.31 vs. 1.71 ± 0.39, P = 0.03), indicating improved autonomic balance. There were no significant differences in MAP, liver function markers (ALT), or kidney function (SCr) between groups at any time point.

Conclusions: RIPC may improve ANS function and MAP stability during cholecystectomy, as shown by better HRV and lower LF/HF ratios. Though the impact on recovery was not significant.