Isoflurane preconditioning-induced cardio-protection in patients undergoing coronary artery bypass grafting

Lee, M. C.; Chen, C. H.; Kuo, Ming Chun; Kang, Pei-Leun; Lo, Amy A.; Liu, K.

doi:10.1017/s0265021506000354

Cited by 58 publications

(29 citation statements)

References 36 publications

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“…Interfering effects of anesthetics such as isoflurane [38], opioids [39] and propofol [34] are frequently debated when it comes to assessing RIPC effects on serum cardiac markers, but a consensus onto what extent they interfere with RIPC has not been reached. RIPC has been demonstrated to reduce postoperative levels of circulating cardiac markers both with [34] and without isoflurane [1], while other studies found no such effect with [40] or without isoflurane [35], or with propofol [34].…”

Section: Discussionmentioning

confidence: 99%

Remote ischemic preconditioning preserves mitochondrial function and activates pro-survival protein kinase Akt in the left ventricle during cardiac surgery: A randomized trial

Slagsvold¹,

Moreira²,

Rognmo³

et al. 2014

International Journal of Cardiology

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Section: Discussionmentioning

confidence: 99%

Remote ischemic preconditioning preserves mitochondrial function and activates pro-survival protein kinase Akt in the left ventricle during cardiac surgery: A randomized trial

Slagsvold¹,

Moreira²,

Rognmo³

et al. 2014

International Journal of Cardiology

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“…133 Volatile anesthetics (sevoflurane, isoflurane, and desflurane) have, in several experimental and clinical settings, been shown to protect the heart from I/R injury. [134][135][136][137] Recently, isoflurane was demonstrated to have a similar effect on the rat liver, 138 and sevoflurane, in a prospective randomized study, protected the human liver from I/R injury during liver resection. 139 It is our practice to administer volatile anesthetics at least during the last 30 min before aortic cross clamping.…”

Section: Pulmonary Carementioning

confidence: 98%

Brain death and its implications for management of the potential organ donor

Bugge

2009

Acta Anaesthesiol Scand

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The systemic physiologic changes that occur during and after brain death affect all organs suitable for transplantation. Major changes occur in the cardiovascular, pulmonary, endocrine, and immunological systems, and, if untreated may soon result in cardiovascular collapse and somatic death. Understanding these complex physiologic changes is mandatory for developing effective strategies for donor resuscitation and management in such a way that the functional integrity of potentially transplantable organs is maintained. This review elucidates these physiological changes and their consequences, and based on these consequences the rationale behind current medical management of brain-dead organ donors is discussed.

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“…39, 40 Its precise role in myocardial tissue remains to be resolved. It has been suggested that several anesthetic agents including isoflurane, 41 opioids, 42 and propofol 43 have preconditioning effects that may interfere with RIPC. However, results are inconsistent and reduced cardiac enzyme release after RIPC has been demonstrated in cardiac surgery both with 44 and without isoflurane.…”

Section: Circulation Research February 28 2014mentioning

confidence: 99%

Remote Ischemic Preconditioning Preserves Mitochondrial Function and Influences Myocardial MicroRNA Expression in Atrial Myocardium During Coronary Bypass Surgery

Slagsvold

Rognmo

Høydal

et al. 2014

Circulation Research

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Rationale: Remote ischemic preconditioning (RIPC) has been suggested to induce cardioprotection during cardiac surgery. Maintaining proper atrial function is imperative in preventing arrhythmia and thrombus formation. Mitochondria have been proposed as key targets in conveying RIPC mechanisms and effects. MicroRNA (miR) is emerging as an important regulator of mitochondrial function, arrhythmia, and protection from ischemia and reperfusion. Objective: This study aimed to evaluate the effect of RIPC on mitochondrial respiration and miR expression in human atrial tissue. Methods and Results: Sixty patients undergoing coronary artery bypass graft surgery were randomized to RIPC (n=30) or control (n=30). RIPC was performed preoperatively by inflating a blood pressure cuff on the upper arm to 200 mm Hg for 3×5 minutes, with 5 minutes reperfusion intervals. Biopsies were obtained from the right atrial appendage before and after aortic cross-clamping. Mitochondrial respiration was measured in situ and miR assessed by commercial miR array and quantitative reverse transcription polymerase chain reaction. Postoperative atrial fibrillation occurrence was monitored by biotelemetry. Maximal mitochondrial respiration was preserved throughout surgery after RIPC but significantly reduced (−28%; P <0.05) after aortic cross-clamping in control. Incidence of postoperative atrial fibrillation was lower after RIPC versus control (14% versus 50%; P <0.01). Myocardial expression of miR-133a and miR-133b increased after aortic cross-clamping in both RIPC and control, whereas miR-1 was upregulated in control only. MiR-338-3p expression was higher in RIPC versus control after aortic cross-clamping. Conclusions: RIPC preserves mitochondrial respiration and prevents upregulation of miR-1 in the right atrium during coronary artery bypass graft. Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique identifier: NCT01308138

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Isoflurane preconditioning-induced cardio-protection in patients undergoing coronary artery bypass grafting

Abstract: The present results support the preconditioning effect of isoflurane in patients undergoing coronary artery bypass graft surgery as clinically feasible and providing optimal cardiac protection.

Cited by 58 publications

References 36 publications

Remote ischemic preconditioning preserves mitochondrial function and activates pro-survival protein kinase Akt in the left ventricle during cardiac surgery: A randomized trial

Remote ischemic preconditioning preserves mitochondrial function and activates pro-survival protein kinase Akt in the left ventricle during cardiac surgery: A randomized trial

Brain death and its implications for management of the potential organ donor

Remote Ischemic Preconditioning Preserves Mitochondrial Function and Influences Myocardial MicroRNA Expression in Atrial Myocardium During Coronary Bypass Surgery

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