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Peri‐operative anaesthetic myocardial preconditioning and protection – cellular mechanisms and clinical relevance in cardiac anaesthesia
Author(s) -
Kunst G.,
Klein A. A.
Publication year - 2015
Publication title -
anaesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.839
H-Index - 117
eISSN - 1365-2044
pISSN - 0003-2409
DOI - 10.1111/anae.12975
Subject(s) - medicine , general anaesthesia , anesthesia , clinical trial , ischemic preconditioning , general anaesthetic , perioperative , myocardial ischemia , cardiac surgery , clinical significance , ischemia , intensive care medicine , cardiology
Summary Preconditioning has been shown to reduce myocardial damage caused by ischaemia–reperfusion injury peri‐operatively. Volatile anaesthetic agents have the potential to provide myocardial protection by anaesthetic preconditioning and, in addition, they also mediate renal and cerebral protection. A number of proof‐of‐concept trials have confirmed that the experimental evidence can be translated into clinical practice with regard to postoperative markers of myocardial injury; however, this effect has not been ubiquitous. The clinical trials published to date have also been too small to investigate clinical outcome and mortality. Data from recent meta‐analyses in cardiac anaesthesia are also not conclusive regarding intra‐operative volatile anaesthesia. These inconclusive clinical results have led to great variability currently in the type of anaesthetic agent used during cardiac surgery. This review summarises experimentally proposed mechanisms of anaesthetic preconditioning, and assesses randomised controlled clinical trials in cardiac anaesthesia that have been aimed at translating experimental results into the clinical setting.