Halogenated Agents and Cardiovascular Surgery: Has Mortality Really Decreased?

Area of Science:

• Anesthesiology
• Cardiology
• Cellular Biology

Background:

• Halogenated anesthetic agents (desflurane, isoflurane, sevoflurane) demonstrate potential cardioprotective effects.
• These effects are observed at therapeutic doses, particularly against myocardial intraoperative ischemia-reperfusion injury.
• Mechanisms involve mitochondrial and anti-apoptotic signaling pathways.

Purpose of the Study:

• To review the rationale for perioperative use of halogenated anesthetics.
• To discuss their mechanisms of action, experimental evidence, and human studies.
• To explore considerations, concerns, and future perspectives for their application.

Main Methods:

• Review of experimental and human studies on halogenated anesthetics.
• Analysis of mechanisms of cardioprotection.
• Evaluation of clinical outcomes in cardiac surgery and other settings.

Main Results:

• Halogenated anesthetics may reduce myocardial infarct size and mechanical ventilation needs in cardiac surgery.
• Evidence suggests potential benefits in reducing morbidity and mortality.
• Total intravenous propofol anesthesia may be detrimental in comparison.

Conclusions:

• Perioperative use of halogenated anesthetics is supported by mechanistic, experimental, and clinical evidence for cardioprotection.
• Their application may extend to major non-cardiac surgery and intensive care unit patients.
• Further research is warranted to optimize their use and explore new perspectives.