Br J Anaesth. 2025 Dec 4:S0007-0912(25)00796-2. Revista: 10.1016/j.bja.2025.11.005. Online ahead of print.

The remote ischemic PReconditioning In Non-Cardiac surgEry (PRINCE) trial was a multinational, double-blind trial in which 1213 patients undergoing noncardiac surgical procedures were randomly assigned to receive remote ischaemic preconditioning (RIPC) or sham-RIPC after general anaesthesia and before surgery to reduce myocardial injury. Postoperative myocardial injury, defined alone by postoperative high-sensitivity troponin above the highest 99th percentile of reference values, occurred in 215/566 patients (38.0%) in the RIPC group and in 223/596 patients (37.4%) in the sham-RIPC group. The PRINCE trial adds to an apparently contradictory literature on the role of RIPC in perioperative medicine. We discuss both trial-specific and mechanistic reasons to explain these discrepancies, and we contend that a role for RIPC in minimising organ injury as a result of noncardiac surgery remains possible.

PubMed:41350217 | Revista:10.1016/j.bja.2025.11.005