Ischemic injury and its prevention

Perioperative ischemia is common in patients at risk of or with known artery disease undergoing noncardiac or cardiac surgery. Resultant ischemic injury can lead to a delay in extubation and hospital discharge, impaired quality of life after surgery, and a disproportionate consumption of health resources. Our goal as anesthesiologists is to prevent this poor perioperative cardiac outcome, to continually strive for improved patient care, and to reduce medical resource consumption. These goals are the driving force behind the recent increased interest in the use of minimally invasive direct vision coronary artery bypass graft techniques. This report discusses the definition and etiology of ischemia and the perioperative management strategies available to prevent ischemic injury, with emphasis on cardioprotective strategies (ischemic reconditioning, regional anesthesia, substrate provision) for minimally invasive direct vision coronary artery bypass surgery. Brief mention is also made of ischemic injury to other organ systems that may delay patient recovery.