title: [Myocardial protection in cardiac surgery.].
abstract: OBJECTIVE
  Myocardial protection defines the set of strategies aiming at attenuating the intensity of myocardial ischemia-reperfusion injury during heart surgery and its harmful consequences on myocardial function. A better understanding of pathophysiological phenomena related to ischemia-reperfusion events and of the anesthetic-induced heart protection has given to the anesthesiologist a major role in intraoperative myocardial protection. The objective of this update was to review the mechanisms of ischemia-reperfusion-induced myocardial injury and myocardial protection modalities focusing on anesthetic techniques.
  
  
  BACKGROUND
  Ischemia-reperfusion-induced myocardial injury mechanisms and their clinical consequences on heart as well as myocardial protection techniques used during heart surgery are addressed in this review. Special emphasis is given to the role of anesthetic drugs and techniques such as inhaled halogenate anesthetics, opioids and adjuvant anesthetic drugs, since they have been shown to have heart protecting effects during cardiac surgery.
  
  
  CONCLUSIONS
  The association of adequate anesthetic technique using heart protecting agents to usual myocardial protection modalities performed by the surgeon may contribute to the prevention of cardiac surgery-induced myocardial dysfunction and improve postoperative outcome.
authors.affiliation: Serviço de Anestesiologia e Terapia Intensiva Cirúrgica, Instituto do Coração, HCFMUSP.
authors.forename: Luiz Marcelo Sá
authors.initials: LM
authors.lastname: Malbouisson
authors.forename: Luciana Moraes Dos
authors.initials: LM
authors.lastname: Santos
authors.forename: José Otávio Costa
authors.initials: JO
authors.lastname: Auler
authors.forename: Maria José Carvalho
authors.initials: MJ
authors.lastname: Carmona