Ercolani et al1 have very effectively discussed the use of vascular clamping in hepatic surgery. Historically, its use has been discouraged because of its association with ischemia-reperfusion injury due to sudden release of reactive oxygen species on declamping. However, Murry and colleagues2 found that brief periods of intermittent clamping and declamping before the actual ischemic insult protects against ischemia-reperfusion injury. This concept is known as ischemic preconditioning. Another, similar concept was put forward by Okamoto et al,3 who showed that intermittent reperfusion rather than sudden reperfusion protects against ischemia-reperfusion injury at the end of vascular occlusion. This is now known as postconditioning. These concepts can be applied to any surgery that involves vascular clamping and occlusion.
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