Peri-operative anaesthetic myocardial preconditioning and protection - cellular mechanisms and clinical relevance in cardiac anaesthesia

Anaesthesia
G Kunst, A A Klein

Abstract

Preconditioning has been shown to reduce myocardial damage caused by ischaemia-reperfusion injury peri-operatively. Volatile anaesthetic agents have the potential to provide myocardial protection by anaesthetic preconditioning and, in addition, they also mediate renal and cerebral protection. A number of proof-of-concept trials have confirmed that the experimental evidence can be translated into clinical practice with regard to postoperative markers of myocardial injury; however, this effect has not been ubiquitous. The clinical trials published to date have also been too small to investigate clinical outcome and mortality. Data from recent meta-analyses in cardiac anaesthesia are also not conclusive regarding intra-operative volatile anaesthesia. These inconclusive clinical results have led to great variability currently in the type of anaesthetic agent used during cardiac surgery. This review summarises experimentally proposed mechanisms of anaesthetic preconditioning, and assesses randomised controlled clinical trials in cardiac anaesthesia that have been aimed at translating experimental results into the clinical setting.

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Citations

Nov 26, 2015·Journal of Cardiothoracic and Vascular Anesthesia·Paul S Pagel
Sep 9, 2015·Anaesthesia·A M E Spoelstra-de ManY M Smulders
Feb 17, 2015·Anaesthesia·N JivrajM Marber
May 12, 2015·Anaesthesia·V SivaramanD J Hausenloy
Jul 20, 2016·Journal of Cardiothoracic and Vascular Anesthesia·Valery V LikhvantsevRostislav A Cherpakov
Jul 31, 2016·Journal of Cardiothoracic and Vascular Anesthesia·Chen-Hsiu ChenCheng-Cheng Huang
Nov 7, 2016·Anesthesiology Clinics·Radwan Safa, Nicholas Sadovnikoff
Feb 17, 2017·British Journal of Anaesthesia·R Mouton, J Soar
Sep 21, 2016·Shock·Christina HafnerKlaus Ulrich Klein
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Apr 20, 2018·Journal of Cellular and Molecular Medicine·Tobias HilbertSven Klaschik
Oct 21, 2017·Aging Clinical and Experimental Research·Elpidio SantilloRaffaele Antonelli-Incalzi
Jul 4, 2019·The New England Journal of Medicine·Nirvik PalJohn Butterworth
Oct 15, 2019·Anesthesia and Analgesia·Jia L StevensDaniel S Martin
May 1, 2020·Seminars in Cardiothoracic and Vascular Anesthesia·Nathan ClendenenNathaen Weitzel
Jul 17, 2019·BMC Neuroscience·Robert H ThieleZhiyi Zuo
May 26, 2018·Journal of Cardiovascular Translational Research·John H RosenbergDevendra K Agrawal
Mar 20, 2019·The New England Journal of Medicine·Giovanni LandoniUNKNOWN MYRIAD Study Group
Jul 4, 2019·The New England Journal of Medicine·Giovanni LandoniVladimir V Lomivorotov
Nov 20, 2019·Anesthesia and Analgesia·Jia L StevensDaniel S Martin
Jan 17, 2020·Hypertension Research : Official Journal of the Japanese Society of Hypertension·Hiroyuki MinatoYoshimi Inagaki
Sep 12, 2017·Anaesthesia·H Hammerbeck
Jul 4, 2019·The New England Journal of Medicine·Michael ZauggEliana Lucchinetti
Oct 15, 2020·Journal of Cardiothoracic and Vascular Anesthesia·Sophia LinYibin Wang
Jun 25, 2019·Anaesthesia Critical Care & Pain Medicine·Osama Abou-ArabNicolas Mongardon
Nov 12, 2020·Minerva anestesiologica·Ciana McCARTHYNick Fletcher

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Methods Mentioned

BETA
coronary artery bypass

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