Volatile anaesthetics and cardioprotection – lessons from animal studies

Abstract

Volatile anaesthetics emerged as important cardioprotective agents in both animal models of ischaemia/reperfusion injury and humans with coronary artery disease. Their administration before a prolonged ischaemic episode is known as anaesthetic preconditioning, whereas when given at the very onset of reperfusion, the strategy is termed anaesthetic postconditioning. Both types of anaesthetic conditioning reduce, albeit not to the same degree, the extent of myocardial injury. They share similar, albeit not identical, intracellular signal transduction pathways with their widely investigated counterparts, ischaemic pre- and postconditioning. Despite a wealth of preclinical evidence for cardioprotection for anaesthetic conditioning strategies, their translation into clinical therapy has been rather disappointing. This review highlights the major findings on the cardioprotective effects of volatile anaesthetics in experimental settings. It explores hypotheses that may explain the lack of efficacy observed in several past clinical studies paving the way for future preclinical and translational studies.

Protective effects of ranolazine and propranolol, alone or combined, on the structural and functional alterations of cardiomyocyte mitochondria in a pig model of ischemia/reperfusion

“…Prolonged myocardial ischemia (approximately 45 min) can induce severe and irreversible cardiac lesions , due to the generation of reactive oxygen species (ROS) and intracellular calcium overload . The combination of both phenomena leads to the opening of mitochondrial permeability transition pores: mPTP . Furthermore, intracellular calcium overload results in electro‐mechanic dysfunction or cell death .…”

Pre-Conditioning with Low-Level Laser (Light) Therapy: Light before the Storm

“…Preconditioning with resveratrol has been found to induce brain tolerance against ischemia by suppression of the inflammatory response via regulation of NF-κB, COX-2 and iNOS (Simao et al, 2012). The administration of volatile anesthetics before a prolonged ischemic episode is known as anesthetic preconditioning, which has been developed as a cardioprotective modality in both animal and humans coronary disease models (Muntean et al, 2013). Moreover, pre-conditioning with anesthetics such as xenon gas can also exert neuroprotective and cardioprotective effects in different models suggesting the use of xenon preconditioning as an alternative strategy for the prevention of various neurological and cardiovascular diseases .…”

Early treatment with isoflurane attenuates left ventricular dysfunction and improves survival in experimental Takotsubo

“…Wake up time after isoflurane‐sedation in the ICU is short and similar to, or faster than propofol . Isoflurane seem to exert cardioprotection in clinical myocardial ischemia/reperfusion injury . In patients undergoing coronary artery bypass surgery, patients sedated with isoflurane had a lower troponin release over time compared to propofol .…”