The Effect of Isoflurane on Survival and Myocardial Infarction: A Meta-analysis of Randomized Controlled Studies

Bignami, Elena; Greco, Teresa; Barile, Luigi; Silvetti, Simona; Nicolotti, Davide; Fochi, Oliviero; Cama, Elio; Costagliola, R; Landoni, Giovanni; Biondi‐Zoccai, Giuseppe; Zangrillo, Alberto

doi:10.1053/j.jvca.2012.06.007

Cited by 31 publications

(17 citation statements)

References 53 publications

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“…204 Most studies have shown that a fixed perfusion defect, which reflects infarcted myocardium, has a low positive predictive value for perioperative cardiac events. However, patients with fixed defects have shown increased risk for long-term events relative to patients with a normal MPI test, which likely reflects ‡References 166,190,193,195,197,199,[202][203][204][205][206] …”

Section: Radionuclide Mpimentioning

confidence: 99%

2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery

Fleisher¹,

Fleischmann²,

Auerbach³

et al. 2014

Circulation

916

495

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Section: Radionuclide Mpimentioning

confidence: 99%

2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery

Fleisher¹,

Fleischmann²,

Auerbach³

et al. 2014

Circulation

916

495

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“…The effects of Anesthetics as cardioprotective agents are well-known and anaesthesic preconditioning (APC) is capable of a reduction of infarct size and mortality after myocardial infarction 2,3 , troponin I release after coronary artery bypass graft surgery 4 and prevention of acute kidney injury 5 . However, little is known on how APC influences the autonomic modulation of the heart after the acute phase of a myocardial ischemia-reperfusion.…”

Section: Introductionmentioning

confidence: 99%

Sevoflurane preconditioning during myocardial ischemia-reperfusion reduces infarct size and preserves autonomic control of circulation in rats

Pasqualin

Mostarda²,

Souza³

et al. 2016

Acta Cir. Bras.

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PURPOSE:To investigate the myocardial ischemia-reperfusion with sevoflurane anesthetic preconditioning (APC) would present beneficial effects on autonomic and cardiac function indexes after the acute phase of a myocardial ischemia-reperfusion. METHODS:Twenty Wistar rats were allocated in three groups: control (CON, n=10), myocardial infarction with sevoflurane (SEV, n=5) and infarcted without sevoflurane (INF, n=5). Myocardial ischemia (60 min) and reperfusion were performed by temporary coronary occlusion. Twenty-one days later, the systolic and diastolic function were evaluated by echocardiography; spectral analysis of the systolic arterial pressure (SAPV) and heart rate variability (HRV) were assessed. After the recording period, the infarct size (IS) was evaluated. RESULTS:The INF group presented greater cardiac dysfunction and increased sympathetic modulation of the SAPV, as well as decreased alpha index and worse vagal modulation of the HRV. The SEV group exhibited attenuation of the systolic and diastolic dysfunction and preserved vagal modulation (square root of the mean squared differences of successive R-R intervals and high frequency) of HRV, as well as a smaller IS. CONCLUSION:Sevoflurane preconditioning better preserved the cardiac function and autonomic modulation of the heart in postacute myocardial infarction period.Key words: Autonomic Nervous System. Heart Rate. Myocardial Infarction. Ischemic Preconditioning, Myocardial. Rats. Sevoflurane preconditioning during myocardial ischemia-reperfusion reduces infarct size and preserves autonomic control of circulation in rats

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“…The cardioprotective effect of volatile anesthetics compared with propofol in patients who undergo heart surgery was confirmed in later studies 76,77. Tritapepe et al showed that the continuous administration of desflurane at a minimum alveolar concentration during aortocoronary bypass surgery decreased myocardial damage, with lower troponin I levels when compared with the infusion of propofol 77…”

Section: Ischemic Prec and Anestheticmentioning

confidence: 86%

Cardioprotection with halogenated gases: how does it occur?

Guerrero-Orriach

Belmonte

Fernández

et al. 2017

DDDT

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Numerous studies have studied the effect of halogenated agents on the myocardium, highlighting the beneficial cardiac effect of the pharmacological mechanism (preconditioning and postconditioning) when employed before and after ischemia in patients with ischemic heart disease. Anesthetic preconditioning is related to the dose-dependent signal, while the degree of protection is related to the concentration of the administered drug and the duration of the administration itself. Triggers for postconditioning and preconditioning might have numerous pathways in common; mitochondrial protection and a decrease in inflammatory mediators could be the major biochemical elements. Several pathways have been identified, including attenuation of NFκB activation and reduced expression of TNFα, IL-1, intracellular adhesion molecules, eNOS, the hypercontraction reduction that follows reperfusion, and antiapoptotic activating kinases (Akt, ERK1/2). It appears that the preconditioning and postconditioning triggers have numerous similar paths. The key biochemical elements are protection of the mitochondria and reduction in inflammatory mediators, both of which are developed in various ways. We have studied this issue, and have published several articles on cardioprotection with halogenated gases. Our results confirm greater cardioprotection through myocardial preconditioning in patients anesthetized with sevoflurane compared with propofol, with decreasing levels of troponin and N-terminal brain natriuretic peptide prohormone. The difference between our studies and previous studies lies in the use of sedation with sevoflurane in the postoperative period. The results could be related to a prolonged effect, in addition to preconditioning and postconditioning, which could enhance the cardioprotective effect of sevoflurane in the postoperative period. With this review, we aim to clarify the importance of various mechanisms involved in preconditioning and postconditioning with halogenated gases, as supported by our studies.

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The Effect of Isoflurane on Survival and Myocardial Infarction: A Meta-analysis of Randomized Controlled Studies

Cited by 31 publications

References 53 publications

2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery

2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery

Sevoflurane preconditioning during myocardial ischemia-reperfusion reduces infarct size and preserves autonomic control of circulation in rats

Cardioprotection with halogenated gases: how does it occur?

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