Letter by Zhang et al Regarding Article, “Randomized Comparison of Sevoflurane Versus Propofol to Reduce Perioperative Myocardial Ischemia in Patients Undergoing Noncardiac Surgery”

Zhang, Junlong; Hua, Dong; Yang, Jan-Ping

doi:10.1161/circulationaha.112.000832

Cited by 3 publications

(2 citation statements)

References 3 publications

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“…Sevoflurane did not reduce the incidence of myocardial ischaemia in high‐risk patients undergoing major non‐cardiac surgery (Lurati Buse et al ., ). However, the study was considered underpowered by others and the endpoints as well as the timing of endpoint measurements were criticized (Zaugg and Lucchinetti, ; Zhang et al ., ).…”

Section: Clinical Studiesmentioning

confidence: 97%

Anaesthetics as cardioprotectants: translatability and mechanism

Kikuchi

Došenović

Bienengraeber

2015

British J Pharmacology

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The pharmacological conditioning of the heart with anaesthetics, such as volatile anaesthetics or opioids, is a phenomenon whereby a transient exposure to an anaesthetic agent protects the heart from the harmful consequences of myocardial ischaemia and reperfusion injury. The cellular and molecular mechanisms of anaesthetic conditioning appear largely to mimic those of ischaemic pre-and post-conditioning. Progress has been made on the understanding of the underlying mechanisms although the order of events and the specific targets of anaesthetics that trigger protection are not always clear. In the laboratory, the protection afforded by certain anaesthetics against cardiac ischaemia and reperfusion injury is powerful and reproducible but this has not necessarily translated into similarly robust clinical benefits. Indeed, clinical studies and meta-analyses delivered variable results when comparing in the laboratory setting protective and non-protective anaesthetics. Reasons for this include underlying conditions such as age, obesity and diabetes. Animal models for disease or ageing, human cardiomyocytes derived from stem cells of patients and further clinical studies are employed to better understand the underlying causes that prevent a more robust protection in patients. LINKED ARTICLESThis article is part of a themed section on Conditioning the Heart -Pathways to Translation. To view the other articles in this section visit http://dx.doi.org/10. 1111/bph.2015.172.issue-8 Abbreviations eNOS, endothelial nitric oxide synthase; GSK3β, glycogen synthase kinase 3β; iPSCs, induced pluripotent stem cells; KATP channel, ATP-sensitive potassium channel; ROS, reactive oxygen species BJP British Journal of Pharmacology

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Section: Clinical Studiesmentioning

confidence: 97%

Anaesthetics as cardioprotectants: translatability and mechanism

Kikuchi

Došenović

Bienengraeber

2015

British J Pharmacology

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“…Another randomised, controlled trial compared sevoflurane with propofol in 385 patients undergoing various non‐cardiac surgeries who had coronary artery disease, or more than one risk factor for coronary artery disease: there was no difference in the rate of myocardial ischaemia . Again, this study was criticised for not monitoring myocardial ischaemia for longer . There are many reasons why the apparent cardioprotective effect of volatile agents cannot be reproduced in clinical studies.…”

Section: Intra‐operative Anaesthesiamentioning

confidence: 99%

Peri‐operative cardiac protection for non‐cardiac surgery

Wong

Irwin

2015

Anaesthesia

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Summary Cardiovascular complications are an important cause of morbidity and mortality after non‐cardiac surgery. Pre‐operative identification of high‐risk individuals and appropriate peri‐operative management can reduce cardiovascular risk. It is important to continue chronic beta‐blocker and statin therapy. Statins are relatively safe and peri‐operative initiation may be beneficial in high‐risk patients and those scheduled for vascular surgery. The pre‐operative introduction of beta‐blockers reduces myocardial injury but increases rates of stroke and mortality, possibly due to hypotension. They should only be considered in high‐risk patients and the dose should be titrated to heart rate. Alpha‐2 agonists may also contribute to hypotension. Aspirin continuation can increase the risk of major bleeding and offset the benefit of reduced myocardial risk. Contrary to the initial ENIGMA study, nitrous oxide does not seem to increase the risk of myocardial injury. Volatile anaesthetic agents and opioids have been shown to be cardioprotective in animal laboratory studies but these effects have, so far, not been conclusively reproduced clinically.

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