[Myocardial preconditioning in anesthesia: from bench to bedside]

Myocardial ischemic preconditioning is a procedure giving powerful protection against myocardial ischemia and infarction. Clinical application of this property to anesthesia might improve anesthetic management of patients with cardiac diseases. Volatile anesthetics, including sevoflurane and isoflurane, can protect ischemic myocardium by activation of ATP-sensitive K channels (K(ATP)) and several clinical trials show that volatile anesthetics can prevent myocardial damage during operations compared with propofol, a popular intravenous anesthetic. Nicorandil is a potent K(ATP) opener and clinical application of nicorandil also can reduce myocardial damage during anesthetic management of patients undergoing off-pump CABG and patients with cardiac risks undergoing non-cardiac operations. In addition, diabetes mellitus and hyperglycemia may abolish the protective effect of preconditioning by impairing K(ATP). From point of view of clinical application of preconditioning, anesthetic maintenance with volatile anesthetics instead of intravenous anesthetics, such as propofol, and administration of nicorandil throughout perioperative period, is recommended to patients with heart diseases and control of blood glucose is useful to maintain the protective effect of preconditioning.