title: Diabetes, perioperative ischaemia and volatile anaesthetics: consequences of derangements in myocardial substrate metabolism.
abstract: Volatile anaesthetics exert protective effects on the heart against perioperative ischaemic injury. However, there is growing evidence that these cardioprotective properties are reduced in case of type 2 diabetes mellitus. A strong predictor of postoperative cardiac function is myocardial substrate metabolism. In the type 2 diabetic heart, substrate metabolism is shifted from glucose utilisation to fatty acid oxidation, resulting in metabolic inflexibility and cardiac dysfunction. The ischaemic heart also loses its metabolic flexibility and can switch to glucose or fatty acid oxidation as its preferential state, which may deteriorate cardiac function even further in case of type 2 diabetes mellitus.Recent experimental studies suggest that the cardioprotective properties of volatile anaesthetics partly rely on changing myocardial substrate metabolism. Interventions that target at restoration of metabolic derangements, like lifestyle and pharmacological interventions, may therefore be an interesting candidate to reduce perioperative complications. This review will focus on the current knowledge regarding myocardial substrate metabolism during volatile anaesthesia in the obese and type 2 diabetic heart during perioperative ischaemia.
authors: Department of Anesthesiology, Experimental Laboratory for VItal Signs, VU University Medical Center, De Boelelaan 1117, Amsterdam, the Netherlands. c.vandenbrom@vumc.nl
authors: Charissa E
authors: CE
authors: van den Brom
authors: Carolien Se
authors: CS
authors: Bulte
authors: Stephan A
authors: SA
authors: Loer
authors: R Arthur
authors: RA
authors: Bouwman
authors: Christa
authors: C
authors: Boer
mesh_terms: D000280:Administration, Inhalation; D018681:Anesthetics, General / Q000008:administration & dosage*; D000818:Animals; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000378:metabolism*; D006801:Humans; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000378:metabolism* / Q000517:prevention & control; D009206:Myocardium / Q000378:metabolism*; D019990:Perioperative Care / Q000379:methods*; D013379:Substrate Specificity / Q000502:physiology
chemical_list: D018681:Anesthetics, General