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Kunst G, Klein AA. Peri-operative anaesthetic myocardial preconditioning and protection - cellular mechanisms and clinical relevance in cardiac anaesthesia. Anaesthesia. 2015;70(4):467-82doi: 10.1111/anae.12975.
Kunst, G., & Klein, A. A. (2015). Peri-operative anaesthetic myocardial preconditioning and protection - cellular mechanisms and clinical relevance in cardiac anaesthesia. Anaesthesia, 70(4), 467-82. https://doi.org/10.1111/anae.12975
Kunst, G, and Klein, A A. "Peri-operative anaesthetic myocardial preconditioning and protection - cellular mechanisms and clinical relevance in cardiac anaesthesia." Anaesthesia vol. 70,4 (2015): 467-82. doi: https://doi.org/10.1111/anae.12975
Kunst G, Klein AA. Peri-operative anaesthetic myocardial preconditioning and protection - cellular mechanisms and clinical relevance in cardiac anaesthesia. Anaesthesia. 2015 Apr;70(4):467-82. doi: 10.1111/anae.12975. PMID: 25764404; PMCID: PMC4402000.
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Anaesthesia. 2015 Apr;70(4):467-82. doi: 10.1111/anae.12975.

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

Anaesthesia

G Kunst, A A Klein

Affiliations

  1. Department of Anaesthetics, King's College Hospital NHS Foundation Trust, London, UK.

PMID: 25764404 PMCID: PMC4402000 DOI: 10.1111/anae.12975

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.

© 2015 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists of Great Britain and Ireland.

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