Year : 2012 | Volume : 6 | Issue : 2 | Page : 27--34
Ischemia, reperfusion, and myocardial protection ( readdressed)
Department of Anesthesia and Critical Care, Ain Shams University, Cairo, Egypt
Measures to minimize myocardial damage have been an important target of research; therefore, a better understanding of the role of anesthetics in the prevention of myocardial injury may provide anesthesiologists with strategies to improve outcome. Myocardial ischemia initiates a range of cellular events, which are initially mild and become progressively damaging with increasing duration of ischemia. Perioperative myocardial ischemia is a serious adverse event that can increase morbidity and mortality after cardiac and noncardiac surgery. Several treatment approaches that prevent or lessen myocardial ischemia during and after surgery have been proposed. The use of particular anesthetics for the induction and maintenance of general anesthesia is one approach to protect against the adverse effects of ischemia. Experimental data indicate that some anesthetics, such as volatile general anesthetics, exert protective effects against ischemia–reperfusion injury that are independent of their hemodynamic effects. To approach this subject, several points should be well understood, such as myocardial metabolism, the pathophysiology of myocardial ischemia, myocardial stunning and hibernation, the effects of ischemia on myocardial metabolism, reperfusion injury, preconditioning, myocardial protection, temperature control, cardioplegia, ischemic and anesthetic preconditioning, and pharmacotherapy.