Myocardial protection by anesthetic agents against ischemia-reperfusion injury: an update for anesthesiologists.
OBJECTIVE
The aim of this review of the literature was to evaluate the effectiveness of anesthetics in protecting the heart against myocardial ischemia-reperfusion injury.


METHODS
Articles were obtained from the Medline database (1980-, search terms included heart, myocardium, coronary, ischemia, reperfusion injury, infarction, stunning, halothane, enflurane, desflurane, isoflurane, sevoflurane, opioid, morphine, fentanyl, alfentanil sufentanil, pentazocine, buprenorphine, barbiturate, thiopental, ketamine, propofol, preconditioning, neutrophil adhesion, free radical, antioxidant and calcium).


RESULTS
Protection by volatile anesthetics, morphine and propofol is relatively well investigated. It is generally agreed that these agents reduce the myocardial damage caused by ischemia and reperfusion. Other anesthetics which are often used in clinical practice, such as fentanyl, ketamine, barbiturates and benzodiazepines have been much less studied, and their potential as cardioprotectors is currently unknown. There are some proposed mechanisms for protection by anesthetic agents: ischemic preconditioning-like effect, interference in the neutrophil/platelet-endothelium interaction, blockade of Ca2+ overload to the cytosolic space and antioxidant-like effect. Different anesthetics appear to have different mechanisms by which protection is exerted. Clinical applicability of anesthetic agent-induced protection has yet to be explored.


CONCLUSIONS
There is increasing evidence of anesthetic agent-induced protection. At present, isoflurane, sevoflurane and morphine appear to be most promising as preconditioning-inducing agents. After the onset of ischemia, propofol could be selected to reduce ischemia-reperfusion injury. Future clinical application depends on the full elucidation of the underlying mechanisms and on clinical outcome trials.
Kato
Rie
R
Department of Anesthesiology (B1), Graduate School of Medicine, Chiba University, Chiba, Japan. rie.kato@anesth01.m.chiba-u.ac.jp
Foëx
Pierre
P
D000701:Analgesics, Opioid / Q000494:pharmacology; D000777:Anesthetics / Q000494:pharmacology*; D000818:Animals; D003331:Coronary Vessels / Q000187:drug effects; D006801:Humans; D019157:Ischemic Preconditioning, Myocardial; D009020:Morphine / Q000494:pharmacology; D017202:Myocardial Ischemia / Q000503:physiopathology*; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control*; D015742:Propofol / Q000494:pharmacology; D020011:Protective Agents / Q000494:pharmacology*
D000701:Analgesics, Opioid; D000777:Anesthetics; D020011:Protective Agents; D009020:Morphine; D015742:Propofol