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Myocardial protection by anesthetic agents against ischemia-reperfusion injury: an update for anesthesiologists
1Department of Anesthesiology (B1), Graduate School of Medicine, Chiba University, Chiba, Japan. rie.kato@anesth01.m.chiba-u.ac.jp
Insights
Anesthetics like isoflurane, sevoflurane, and morphine may protect the heart from ischemia-reperfusion injury. Propofol may also reduce damage after ischemia onset, but clinical trials are needed.
Area of Science:
- Cardiology
- Anesthesiology
- Pharmacology
Background:
- Myocardial ischemia-reperfusion injury is a significant clinical concern.
- Anesthetic agents are widely used in cardiac procedures and may influence cardiac outcomes.
- Understanding the cardioprotective potential of anesthetics is crucial for patient management.
Purpose of the Study:
- To review and evaluate the effectiveness of various anesthetics in mitigating myocardial ischemia-reperfusion injury.
- To identify anesthetics with demonstrated cardioprotective properties.
Main Methods:
- Comprehensive literature search of Medline database (1980 onwards).
- Inclusion of studies on heart, myocardium, coronary ischemia, reperfusion injury, and specific anesthetic agents (volatile, opioids, barbiturates, etc.).
- Keywords included preconditioning, neutrophil adhesion, free radical, and calcium-related mechanisms.
Main Results:
- Volatile anesthetics (isoflurane, sevoflurane), morphine, and propofol show evidence of reducing myocardial damage.
- The cardioprotective mechanisms may involve ischemic preconditioning-like effects, modulation of inflammatory interactions, calcium overload blockade, and antioxidant properties.
- The cardioprotective potential of other commonly used anesthetics (e.g., fentanyl, ketamine) remains largely uninvestigated.
Conclusions:
- Anesthetic agents demonstrate increasing evidence of cardioprotection against ischemia-reperfusion injury.
- Isoflurane, sevoflurane, and morphine are promising for preconditioning, while propofol may be beneficial post-ischemia onset.
- Further research, including clinical outcome trials, is necessary to fully elucidate mechanisms and guide clinical application.
Purpose:
The aim of this review of the literature was to evaluate the effectiveness of anesthetics in protecting the heart against myocardial ischemia-reperfusion injury.
Source:
Articles were obtained from the Medline database (1980-, search terms included heart, myocardium, coronary, ischemia, reperfusion injury, infarction, stunning, halothane, enflurane, desflurane, isoflurane, sevoflurane, opioid, morphine, fentanyl, alfentanil sufentanil, pentazocine, buprenorphine, barbiturate, thiopental, ketamine, propofol, preconditioning, neutrophil adhesion, free radical, antioxidant and calcium).
Principal Findings:
Protection by volatile anesthetics, morphine and propofol is relatively well investigated. It is generally agreed that these agents reduce the myocardial damage caused by ischemia and reperfusion. Other anesthetics which are often used in clinical practice, such as fentanyl, ketamine, barbiturates and benzodiazepines have been much less studied, and their potential as cardioprotectors is currently unknown. There are some proposed mechanisms for protection by anesthetic agents: ischemic preconditioning-like effect, interference in the neutrophil/platelet-endothelium interaction, blockade of Ca2+ overload to the cytosolic space and antioxidant-like effect. Different anesthetics appear to have different mechanisms by which protection is exerted. Clinical applicability of anesthetic agent-induced protection has yet to be explored.
Conclusion:
There is increasing evidence of anesthetic agent-induced protection. At present, isoflurane, sevoflurane and morphine appear to be most promising as preconditioning-inducing agents. After the onset of ischemia, propofol could be selected to reduce ischemia-reperfusion injury. Future clinical application depends on the full elucidation of the underlying mechanisms and on clinical outcome trials.
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