Clinical importance of anaesthetic preconditioning

Myocardial infarction represents one of the most serious perioperative complications. Reducing the risk of perioperative myocardial infarction is one of the most important priorities of anesthetic treatment. Discovery of cardioprotective effects of volatile anesthetics exerted strong impact on everyday anesthetic practice, particularly in cardiac-surgical setting. Anesthetic preconditioning is a complex process which is divided into two separate phenomena initiated by the same event. The first, referred to as early preconditioning, involves activation of protective enzymes within cardiomyocytes and the second, referred to as late preconditioning, is dependent on de novo synthesis of these protective proteins. Although pre-, as well as post-conditioning's effects on cardiomyocytes are crucial for cardioprotective effects of volatile anesthetics, their influence on coronary endothelium may be even more important for the improvement of the long-term prognosis, demonstrated in coronary surgery patients. Improved outcome after anesthesia with volatile anesthetics in non-cardiac surgical patients at risk of perioperative myocardial infarction has not been univocally demonstrated yet. Some data indicate that volatile anesthetics, especially sevoflurane, reduces inflammatory response to ischaemia-reperfusion and other pro-inflammatory stimuli. The issue of inflammatory modulation exerted by volatile anesthetics and its influence on patients' clinical condition remains to be addressed in future studies.