Preconditioning, anesthetics, and perioperative medication.
Activation of endogenous signal transduction pathways, by a variety of stimuli including ischemic and anesthetic pre- and post-conditioning, protects myocardium against ischemia and reperfusion injury. Experimental evidence suggests that adenosine-regulated potassium channels, cyclooxygenase-2, intracellular kinases, endothelial nitric oxide synthase, and membrane bound receptors play critical roles in signal transduction, and that intracellular signaling pathways ultimately converge on mitochondria to produce cardioprotection. Disease states, and perioperative medications such as sulfonylureas and COX-2 antagonists, could have adverse effects on cardioprotection by impairing activation of ion channels and proteins that are important in cell signaling. Insights gained from animal and clinical studies are reviewed and recommendations given for the use of perioperative anesthetics and medications.
Shim
Yon Hee
YH
Department of Anesthesiology, Pharmacology and Toxicology, The Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA.
Kersten
Judy R
JR
D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D000818:Animals; D009202:Cardiomyopathies / Q000209:etiology / Q000517:prevention & control*; D052246:Cyclooxygenase 2 Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D019157:Ischemic Preconditioning, Myocardial / Q000379:methods*; D019990:Perioperative Care / Q000379:methods*; D015221:Potassium Channels / Q000187:drug effects; D011229:Preanesthetic Medication; D016032:Randomized Controlled Trials as Topic; D015398:Signal Transduction / Q000187:drug effects; D013453:Sulfonylurea Compounds / Q000627:therapeutic use*
D018686:Anesthetics, Intravenous; D052246:Cyclooxygenase 2 Inhibitors; D007004:Hypoglycemic Agents; D015221:Potassium Channels; D013453:Sulfonylurea Compounds