Research progress of isoflurane in alleviating cerebral ischemia/reperfusion injury

Ischemic stroke is one of the leading causes of disability and death worldwide. Despite the effectiveness of thrombolysis and mechanical thrombectomy in restoring blood flow and improving ischemic brain injury, patients often face worsening neurological function due to ischemia/reperfusion (I/R) injury after treatment. I/R injury exacerbates brain damage through various mechanisms, including oxidative stress, neuroinflammation, blood-brain barrier (BBB) disruption, and cell death, which in turn affects patient prognosis and long-term recovery. Isoflurane (ISO), a commonly used inhalational anesthetic, has demonstrated significant neuroprotective effects in preclinical studies in recent years. The mechanisms of action include inhibition of oxidative stress, reduction of neuroinflammation, stabilization of BBB, regulation of cell death pathways, attenuation of excitotoxicity, and promotion of neurological recovery. Additionally, studies have shown that isoflurane provides long-term neuroprotection in rats with brain ischemia. These promising findings suggest that isoflurane could play a role in improving both short-term and long-term outcomes for ischemic stroke patients. However, despite the promising neuroprotective effects of isoflurane in preclinical studies, its clinical application in ischemic stroke patients still requires further validation to determine the optimal anesthesia protocol for improving long-term patient outcomes. This review aims to summarize the potential neuroprotective effects of isoflurane in ischemic stroke, elucidate its mechanisms of action, and provide a theoretical basis for its clinical application. Such insights could lead to improved therapeutic strategies and better patient prognoses in ischemic stroke management.