Cardioprotective effect of inhaled anesthetics

O.O. Pavlov, S.A. Lutsyk

Abstract


Today, there is a difference between the available experimental data from animal studies and clinical outcomes in cardiac and general surgical patients. Protective effect of inhaled anesthetics is based on the same routes, which lay the groundwork of the protection from ischemic preconditioning. The experimental data on sevoflurane and isoflurane use play a leading role in the activation of mitochondrial K+-channels of ATP molecules, similar to what occurs naturally in ischemic lesions. Also, in the experiment it is presented that sevofluranе inhalation improved myocardial contractility recovery to 67 % compared with 28 % in the control group. Another mechanism of cardioprotection is to change the activity of the mitochondrial transition modulation and activation of cytokines, which are the key intracellular signaling pathways of apoptosis. Next cardioprotection mechanism when using inhaled anesthetics is to change the extracellular kinase signal. The conclusions of clinical trials on the use of inhaled anesthetics are presented. Maintaining mitochondrial oxygen consumption indicates cardioprotective effect as a result of isoflurane action. Clinical studies have determined that the strength of ventricular contraction was significantly improved in sevoflurane group (from 53 to 85 %) and in desflurane group (from 53 to 86 %). Despite the significant experimental data, the use of inhaled anesthetics in clinical practice remains controversial. Cardiac surgery is a suitable model for the study of inhaled anesthetics, but the introduction of other anesthetics during surgery on the heart may also affect the results of the study, because data interpretation is a controversial question. Clinical studies of inhaled anesthetics in patients undergoing heart surgery, especially coronary artery bypass grafting, confirm their positive effect in reducing the incidence of myocardial infarction, troponin release, length of hospital stay and mortality. The studies proved that desflurane use was associated with a smaller increase in biochemical markers of myocardial damage compared with total intravenous anesthesia in the postoperative period. In contrast, some authors found no difference in the concentrations of biochemical markers of myocardial damage in patients receiving desflurane or sevoflurane compared with those, who received total intravenous anesthesia in the postoperative period. However, patients receiving inhaled anesthetics have a smaller length of hospital stay and lower mortality in the first year after surgery. In a retrospective study involving more than 10,000 cardiac patients, the use of inhaled anesthetics was associated with better outcomes in the treatment of patients undergoing elective surgery. However, in patients with severe preoperative myocardial ischemia or cardiovascular instability, the use of inhaled anesthetics was associated with a worse outcome than in those receiving total intravenous anesthesia. Some studies provided the evidence to support the efficiency of using inhaled anesthetics in cardiac patients. In the literature, there are data on the positive impact of inhaled anesthetic isoflurane compared with total intravenous anesthesia. International consensus provided expert support for the primary use of inhaled anesthetics in cardiac patients with hemodynamic stability as a mean to reduce myocardial injury and mortality. This consensus concluded that further randomized controlled trials on the use of inhaled anesthetics by cardiac patients were needed. Future studies should evaluate the optimal anesthetic concentration and its protocol for better cardioprotection effect.

Keywords


heart failure; inhaled anesthetics; anesthesia

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DOI: https://doi.org/10.22141/2224-0586.3.82.2017.102323

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