Cardioprotection with volatile anesthetics: clinical relevance.
OBJECTIVE
Increasing experimental evidence is indicating that volatile anesthetic agents may exert direct cardioprotective effects. They have been shown to directly precondition or indirectly enhance ischemic preconditioning. This results in protection against reversible and irreversible ischemic myocardial damage. In addition, volatile anesthetics also decrease the extent of the reperfusion injury when administered only during the reperfusion period. The implementation of these properties during clinical anesthesia might provide an additional tool in the treatment and prevention of ischemic cardiac dysfunction in the perioperative period.


RESULTS
In clinical practice, these effects should be associated with improved cardiac function, ultimately resulting in a better outcome in patients with coronary artery disease. This potential application of anesthetic agents has only recently been explored and its applicability in clinical practice is the subject of ongoing research.


CONCLUSIONS
This review will summarize the current knowledge in this field and also discuss the potential mechanisms involved in cardioprotection by anesthetic agents.
De Hert
Stefan G
SG
Division of Cardiothoracic and Vascular Anesthesia, Department of Anesthesiology, University Hospital Antwerp, Belgium. stefan.dehert@ua.ac.be