Anaesthetic-induced myocardial preconditioning: fundamental basis and clinical implications

被引:11
作者
Chiari, P
Bouvet, F
Piriou, V [1 ]
机构
[1] Ctr Hosp Lyon Sud, Serv Anesthesie Reanimat, EA 1896, F-69495 Pierre Benite, France
[2] Hop Cardiovasc & Pneumol Louis Pradel, Dept Anesthesie Reanimat, INSERM, E 0226, F-69500 Bron, France
[3] Hop La Pitie Salpetriere, Inst Coeur, Serv Reanimat Med, F-75013 Paris, France
来源
ANNALES FRANCAISES D ANESTHESIE ET DE REANIMATION | 2005年 / 24卷 / 04期
关键词
myocardium; ischaemia; protection; preconditioning; halogenated anaesthetics;
D O I
10.1016/j.annfar.2005.01.020
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Objective. - Volatile halogenated anaesthetics offer a myocardial protection when they are administrated before a myocardial ischaemia. Cellular mechanisms involved in anaesthetic preconditioning are now better understood. The objectives of this review are to understand the anaesthetic-induced preconditioning underlying mechanisms and to know the clinical implications. Data sources. - References were obtained from PubMed data bank (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi) using the following keywords: volatile anaesthetic, isoflurane, halothane, sevoflurane, desflurane, preconditioning, protection, myocardium. Data synthesis. - Ischaemic preconditioning (PC) is a myocardial endogenous protection against ischaemia. It has been described as one or several short ischaemia before a sustained ischemia. These short ischaemia trigger a protective signal against this longer ischaemia. An ischemic organ is able to precondition a remote organ. It is possible to replace the short ischaemia by a preadministration of halogenated volatile anaesthetic with the same protective effect, this is called anaesthetic PC (APC). APC and ischaemic PC share similar underlying biochemical mechanisms including protein kinase C, tyrosine kinase activation and mitochondrial and sarcolemnal K-ATP channels opening. All halogenated anaesthetics can produce an anaesthetic PC effect. Myocardial protection during reperfusion, after the long ischaemia, has been shown by successive short ischaemia or volatile anaesthetic administration, this is called postconditioning. Ischaemic PC has been described in humans in 1993. Clinical studies in human cardiac surgery have shown the possibility of anaesthetic PC with volatile anaesthetics. These studies have shown a decrease of postoperative troponin in patient receiving halogenated anaesthetics. (c) 2005 Elsevier SAS. Tous droits reserves.
引用
收藏
页码:383 / 396
页数:14
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