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INVITED REVIEWS

Cardiac pharmacological preconditioning with volatile anesthetics: from bench to bedside?

Departments of ¹Anesthesiology, ²Physiology, and ³Pharmacology and Toxicology and ⁴Department of Medicine, Division of Cardiovascular Diseases, and ⁵Cardiovascular Research Center, Medical College of Wisconsin, Milwaukee 53226; ⁶Department of Biomedical Engineering, Marquette University, Milwaukee 53233; ⁷Clement J. Zablocki Department of Veterans Affairs Medical Center, Milwaukee, Wisconsin 53295; and ⁸Department of Anesthesiology and Intensive Care Medicine, University Hospital Münster, 48129 Münster, Germany

A steadily increasing number of investigations demonstrate that preconditioning with volatile anesthetics attenuates the deleterious effects of myocardial ischemia and reperfusion injury by an ischemic preconditioning-like mechanism. Thus volatile anesthetics may represent the best choice for anesthesia of patients at risk for myocardial ischemia. However, factors such as old age, coexisting conditions such as diabetes mellitus and the use of oral hypoglycemic drugs or cyclooxygenase inhibitors, timing and duration of myocardial ischemia, and possible constraints of a complicated preconditioning protocol may limit the benefits of this powerful tool under clinical conditions. The purpose of this minireview is to provide a brief overview of the results of basic and clinical research on cardioprotection by volatile anesthetics.

age; clinical; diabetes; duration; ischemia-reperfusion injury

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