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Published on: September 24, 2020
Inhalational anaesthetics and cardioprotection
1Department of Anaesthesiology, University of Amsterdam (AMC), Meibergdreef 9, NL-1100 DD, Amsterdam, The Netherlands. N.C.hauck@amc.uva.nl
Handbook of Experimental Pharmacology
|January 5, 2008
Summary
Inhalational anesthetics mimic the heart's natural protective mechanism, offering clinical cardioprotection. This anesthetic pre-conditioning provides a promising strategy to safeguard the myocardium during cardiac events and surgeries.
Area of Science:
- Cardiology
- Anesthesiology
- Biochemistry
Background:
- The heart possesses an endogenous cardioprotection mechanism known as ischemic pre-conditioning.
- Ischemic pre-conditioning, triggered by brief ischemia, protects the myocardium from subsequent ischemic events like myocardial infarction.
- The clinical application of ischemic pre-conditioning is limited, prompting research into alternative methods.
Purpose of the Study:
- To explore the potential of volatile anesthetics to induce cardioprotection.
- To review the mechanisms of anesthetic-induced cardioprotection, including pre-conditioning and post-conditioning.
- To summarize the current understanding of signal transduction pathways involved in anesthetic cardioprotection.
Main Methods:
- Review of laboratory investigations on volatile anesthetic exposure and myocardial protein structure changes.
- Functional blockade studies to identify protein modifications mediating cardioprotection.
- Analysis of animal experimental data on anesthetic interaction with ischemia-reperfusion mechanisms.
- Summary of clinical studies on anesthetic-induced cardioprotection and surrogate outcomes.
Main Results:
- Volatile anesthetics can induce a cardioprotective mechanism similar to ischemic pre-conditioning.
- Changes in myocardial protein structure and distribution, mediated by target enzymes, contribute to anesthetic pre-conditioning.
- Volatile anesthetics also interact with ischemia-reperfusion injury during ischemia and reperfusion (post-conditioning), particularly in animal models.
- Initial clinical studies show promising effects on surrogate outcomes like ICU stay and troponin release.
Conclusions:
- Anesthetic-induced cardioprotection, via pre-conditioning and post-conditioning, offers a clinically relevant strategy for myocardial protection.
- Inhalational anesthetics represent a promising option to protect the myocardium in various clinical situations involving ischemia-reperfusion.
- Further research is warranted to fully elucidate the mechanisms and optimize the clinical application of anesthetic cardioprotection.
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