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Mechanisms of Cardioprotection of Halogenated Agents During Extracorporeal Circulation in Cardiac Surgery

M Ramirez-Aliaga1,2, J J Escalona-Belmonte1,2, A Ramirez-Fernandez1,2

  • 1Department of Cardio-Anaesthesiology, University Hospital Virgen de la Victoria, Malaga, Spain.

Current Vascular Pharmacology
|November 19, 2017
PubMed

Insights

This review covers cardioprotective strategies for cardiac surgery using extracorporeal circulation (ECC). It highlights halogenated anesthetics and pre-/post-conditioning for myocardial protection, noting gaps in intra-ECC anesthetic mechanisms.

Area of Science:

  • Cardiology
  • Anesthesiology
  • Cardiovascular Surgery

Background:

  • Cardiac surgery often requires extracorporeal circulation (ECC), posing risks of myocardial damage.
  • Halogenated anesthetics are commonly used in cardiac anesthesia for their hypnotic and cardioprotective properties.
  • Comprehensive cardioprotective strategies encompass pre-, intra-, and postoperative interventions.

Purpose of the Study:

  • To review the physiopathology of myocardial damage during ECC in cardiac surgery.
  • To explore current and potential cardioprotective strategies against ECC-induced myocardial injury.
  • To identify knowledge gaps regarding anesthetic mechanisms during ECC.

Main Methods:

  • Literature review of studies on cardioprotection during cardiac surgery with ECC.
  • Analysis of the role of halogenated anesthetics in myocardial protection.
  • Examination of pre-conditioning and post-conditioning mechanisms.

Main Results:

  • Pre- and post-conditioning share pathways involving mitochondrial signaling, antiapoptotic effects, and reduced inflammation.
  • Halogenated anesthetics demonstrate cardioprotective effects and hypnotic capacity.
  • The mechanisms of volatile anesthetics administered during ECC remain largely uninvestigated.

Conclusions:

  • Optimal myocardial protection during ECC requires a multi-faceted approach across all surgical phases.
  • Halogenated anesthetics are valuable for cardioprotection and hypnosis in cardiac surgery.
  • Further research is needed to elucidate the intraoperative effects and mechanisms of volatile anesthetics during ECC.

Keywords:
Preconditioningcardiac surgerycardioprotectionextracorporeal circulationhypnotic agentspostconditioning.

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