Document Detail

Cardiac protection by volatile anaesthetics: a review.
MedLine Citation:
PMID:  18393912     Owner:  NLM     Status:  MEDLINE    
Ischaemic preconditioning, a response to brief sublethal episodes of ischaemia leading to a pronounced protection against subsequent lethal ischaemia, is mimicked by some pharmacological agents. Halogenated anaesthetics alone exhibit cardioprotective properties at therapeutic doses, independent of their anaesthetic and haemodynamic effect, leading to the concept of anaesthetic preconditioning. Only recently has research turned to clinical application of preconditioning protocols, and anaesthetic preconditioning has indeed been demonstrated in randomised clinical trials conducted in patients undergoing cardiac surgery - mostly coronary artery bypass graft. Most of these trials demonstrate cardiac protection by assessing postprocedural release of cardiac troponin or early postoperative cardiac function. Few studies focus on clinical outcomes, and none demonstrates an advantage in terms of mortality or cardiac morbidity. A recent meta-analysis, pooling data regarding the use of desflurane and sevoflurane, found significant reductions of in-hospital mortality, myocardial infarction rate, intensive care unit and hospital stay, time on mechanical ventilation and incidence of long term cardiac events. In conclusion, the use of desflurane and sevoflurane appears to yield a better outcome, in terms of mortality and cardiac morbidity, in patients undergoing cardiac surgery. A definitive demonstration of this concept represents a difficult task because of the low mortality rate in modern cardiac surgery and because of the number of interfering factors. Whether these cardioprotective properties also exist in non-coronary surgery settings is still controversial owing to the scarce available data.
Giovanni Landoni; Oliviero Fochi; Giorgio Torri
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Current vascular pharmacology     Volume:  6     ISSN:  1570-1611     ISO Abbreviation:  Curr Vasc Pharmacol     Publication Date:  2008 Apr 
Date Detail:
Created Date:  2008-04-08     Completed Date:  2008-07-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101157208     Medline TA:  Curr Vasc Pharmacol     Country:  United Arab Emirates    
Other Details:
Languages:  eng     Pagination:  108-11     Citation Subset:  IM    
Department of Cardiothoracic Anesthesia, Università, Vita-Salute San Raffaele, Italia e Istituto Scientifico San Raffaele, Milan, Italy.
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MeSH Terms
Anesthetics, Inhalation / therapeutic use*
Coronary Artery Bypass
Heart / drug effects*,  physiopathology
Hospital Mortality
Intensive Care
Ischemic Preconditioning, Myocardial
Isoflurane / analogs & derivatives*,  therapeutic use
Length of Stay
Methyl Ethers / therapeutic use*
Myocardial Infarction / prevention & control*
Troponin / blood
Reg. No./Substance:
0/Anesthetics, Inhalation; 0/Methyl Ethers; 0/Troponin; 26675-46-7/Isoflurane; 28523-86-6/sevoflurane; 57041-67-5/desflurane

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