In this study, RIPC was induced by four cycles of upper limb ischemia via blood-pressure cuff inflation to a minimum of 200 mmHg, with at least 15 mmHg above the patient's systolic pressure. However, in the dog model study cited by the authors as proof-of-concept, the protocol involved a left thoracotomy, with 4 cycles of circumflex occlusions first, followed by a sustained 1 hour LAD occlusion with 4.5 of subsequent reperfusion. While the present study aimed to duplicate a similar result, was the intervention too mild to produce RIPC? While propofol may have appeared a common denominator, might there also have been immunological and physiological components that were just as important?
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