Effects of steal-prone anatomy on intraoperative myocardial ischemia

Leung, Jacqueline M.; Hollenberg, Milton; O’Kelly, Brian; Kao, Ann K.; Mangano, Dennis T.

doi:10.1016/0735-1097(92)90379-2

Cited by 14 publications

(3 citation statements)

References 32 publications

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“…Key factors responsible for this controversy have been poor control of haemodynamics and lack of evidence supporting steal‐prone anatomy. For example, in patients undergoing CABG, adequate control of haemodynamics was not associated with isoflurane‐induced coronary artery steal ( Leung et al , 1991 , 1992 ).…”

Section: Anaesthetics As Cardioprotective Agentsmentioning

confidence: 99%

Inflammatory response and cardioprotection during open‐heart surgery: the importance of anaesthetics

Suleiman

Zacharowski

Angelini

2008

British J Pharmacology

137

108

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Open-heart surgery triggers an inflammatory response that is largely the result of surgical trauma, cardiopulmonary bypass, and organ reperfusion injury (e.g. heart). The heart sustains injury triggered by ischaemia and reperfusion and also as a result of the effects of systemic inflammatory mediators. In addition, the heart itself is a source of inflammatory mediators and reactive oxygen species that are likely to contribute to the impairment of cardiac pump function. Formulating strategies to protect the heart during open heart surgery by attenuating reperfusion injury and systemic inflammatory response is essential to reduce morbidity. Although many anaesthetic drugs have cardioprotective actions, the diversity of the proposed mechanisms for protection (e.g. attenuating Ca 2 þ overload, anti-inflammatory and antioxidant effects, pre-and post-conditioning-like protection) may have contributed to the slow adoption of anaesthetics as cardioprotective agents during open heart surgery. Clinical trials have suggested at least some cardioprotective effects of volatile anaesthetics. Whether these benefits are relevant in terms of morbidity and mortality is unclear and needs further investigation. This review describes the main mediators of myocardial injury during open heart surgery, explores available evidence of anaesthetics induced cardioprotection and addresses the efforts made to translate bench work into clinical practice.

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Section: Anaesthetics As Cardioprotective Agentsmentioning

confidence: 99%

Inflammatory response and cardioprotection during open‐heart surgery: the importance of anaesthetics

Suleiman

Zacharowski

Angelini

2008

British J Pharmacology

137

108

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“…This has been defined as a total occlusion of one coronary artery and a ≥ 50% stenosis of a second artery that supplies collateral blood vessels to the former vessel and can be visualised by coronary angiography or contrast echocardiography. It occurs in 23–33% of patients with coronary heart disease [3, 4]. Systemic hypotension stimulates coronary artery autoregulation, resulting in local coronary vasodilatation in an attempt to increase blood flow to the myocardium.…”

Section: Mechanisms Of Myocardial Injury and The Role Of Isofluranementioning

confidence: 99%

“…Leung et al . [4] studied 186 patients undergoing CABG and found no differences between the isoflurane and sufentanil groups or those with and without steal‐prone anatomy. Both these studies maintained coronary perfusion pressure by ensuring that arterial blood pressure and heart rate were kept within narrow ranges from baseline.…”

Section: Mechanisms Of Myocardial Injury and The Role Of Isofluranementioning

confidence: 99%

Isoflurane and coronary heart disease

Agnew¹,

Pennefather

Russell

2002

Anaesthesia

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SummaryEarly studies indicated that isoflurane caused coronary steal and should therefore be avoided in patients with coronary heart disease. Subsequently, more detailed trials have disputed this and have shown that as long as coronary perfusion pressure is maintained, isoflurane does not cause coronary steal or myocardial ischaemia. There is now growing evidence, initially in animal work but more recently in human studies, that isoflurane has myocardial protective properties, limiting infarct size and improving functional recovery from myocardial ischaemia. The mechanism for this protection mimics ischaemic preconditioning and involves the opening of adenosine triphosphate-dependent potassium channels. The few studies comparing the myocardial protection offered by individual anaesthetic agents indicate that isoflurane represents the anaesthetic agent of choice for patients with coronary heart disease.

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