Source: http://emergency.zaslavsky.com.ua/article/view/102323
Timestamp: 2019-04-18 18:48:28+00:00

Document:
Today, there is a difference between the available experimental data from animal studies and clinical outcomes in cardiac and general surgical patients. Protective effect of inhaled anesthetics is based on the same routes, which lay the groundwork of the protection from ischemic preconditioning. The experimental data on sevoflurane and isoflurane use play a leading role in the activation of mitochondrial K+-channels of ATP molecules, similar to what occurs naturally in ischemic lesions. Also, in the experiment it is presented that sevofluranе inhalation improved myocardial contractility recovery to 67 % compared with 28 % in the control group. Another mechanism of cardioprotection is to change the activity of the mitochondrial transition modulation and activation of cytokines, which are the key intracellular signaling pathways of apoptosis. Next cardioprotection mechanism when using inhaled anesthetics is to change the extracellular kinase signal. The conclusions of clinical trials on the use of inhaled anesthetics are presented. Maintaining mitochondrial oxygen consumption indicates cardioprotective effect as a result of isoflurane action. Clinical studies have determined that the strength of ventricular contraction was significantly improved in sevoflurane group (from 53 to 85 %) and in desflurane group (from 53 to 86 %). Despite the significant experimental data, the use of inhaled anesthetics in clinical practice remains controversial. Cardiac surgery is a suitable model for the study of inhaled anesthetics, but the introduction of other anesthetics during surgery on the heart may also affect the results of the study, because data interpretation is a controversial question. Clinical studies of inhaled anesthetics in patients undergoing heart surgery, especially coronary artery bypass grafting, confirm their positive effect in reducing the incidence of myocardial infarction, troponin release, length of hospital stay and mortality. The studies proved that desflurane use was associated with a smaller increase in biochemical markers of myocardial damage compared with total intravenous anesthesia in the postoperative period. In contrast, some authors found no difference in the concentrations of biochemical markers of myocardial damage in patients receiving desflurane or sevoflurane compared with those, who received total intravenous anesthesia in the postoperative period. However, patients receiving inhaled anesthetics have a smaller length of hospital stay and lower mortality in the first year after surgery. In a retrospective study involving more than 10,000 cardiac patients, the use of inhaled anesthetics was associated with better outcomes in the treatment of patients undergoing elective surgery. However, in patients with severe preoperative myocardial ischemia or cardiovascular instability, the use of inhaled anesthetics was associated with a worse outcome than in those receiving total intravenous anesthesia. Some studies provided the evidence to support the efficiency of using inhaled anesthetics in cardiac patients. In the literature, there are data on the positive impact of inhaled anesthetic isoflurane compared with total intravenous anesthesia. International consensus provided expert support for the primary use of inhaled anesthetics in cardiac patients with hemodynamic stability as a mean to reduce myocardial injury and mortality. This consensus concluded that further randomized controlled trials on the use of inhaled anesthetics by cardiac patients were needed. Future studies should evaluate the optimal anesthetic concentration and its protocol for better cardioprotection effect.
Whalen F.X. Inhaled anesthetics: an historical overview / Whalen F.X., Bacon D.R., Smith H.M. // Best Practical Rescue Clinical Anaesthesiology. — 2015. — V. 19. — P. 323-330.
Yung L.M. Sphingosine kinase 2 mediates cerebral preconditioning and protects the mouse brain against ischemic injury / Yung L.M., Wei Y., Qin T., Wang Y., Smith C.D., Waeber C. // Stroke. — 2012. — V. 43. — P. 199-204.
Altay O. Isoflurane delays the development of early brain injury after subarachnoid hemorrhage through sphingosine-related pathway activation in mice / Altay O., Hasegawa Y., Sherchan P., Suzuki H. // Critical Care Medicine. — 2012. — V. 40. — P. 1908-1913.
Julier K. Preconditioning by sevoflurane decreases biochemical markers for myocardial and renal dysfunction in coronary artery bypass graft surgery: a double-blinded, placebo-controlled, multicenter study / Julier K., da Silva R., Garcia C. // Anesthesiology. — 2013. — V. 98. — P. 1315-1327.
Lee H.T. Sevoflurane-mediated TGF-beta1 signaling in renal proximal tubule cells / Lee H.T., Kim M., Song J.H., Chen S.W. // American Physiology Renal. — 2015. — V. 294. — P. 371-378.
Kim M. Isoflurane mediates protection from renal ische­mia-reperfusion injury via sphingosine kinase and sphingosine-1-phosphate-dependent pathways / Kim M., Kim M., Kim N., D`Agati V.D. // American Physiology Renal. — 2013. — V. 293. — P. 1827-1835.
Kim M. Isoflurane protects human kidney proximal tubule cells against necrosis via sphingosine kinase and sphingosine-1-phosphate generation / Kim M., Kim M., Park S.W. // American Nephrology. — 2012. — V. 31. — P. 353-362.
Lee H.T. TGF-beta1 release by volatile anesthetics media­tes protection against renal proximal tubule cell necrosis / Lee H.T., Kim M., Kim J. // American Nephrology. — 2014. — V. 27. — P. 416-424.
Lee H.T. Anti-inflammatory and antinecrotic effects of the volatile anesthetic sevoflurane in kidney proximal tubule cells / Lee H.T., Kim M., Jan M., Emala C.W. // American Physiology Renal. — 2013. — V. 291. — P. 67-78.
Warltier D. Approaches to the prevention of perioperative myocardial ischemia / Warltier D., Kersten J.R. // Anesthesio­logy. — 2010. — V. 9. — P. 253-259.
Bignami E. Volatile anesthetics reduce mortality in cardiac surgery / Bignami E., Biondi-Zoccai G., Landoni G., Fochi O. // Cardiothoracic Vascular Anesthesiology. — 2012. — V. 23. — P. 594-599.
Zaugg M. Volatile anesthetics mimic cardiac preconditioning by priming the activation of mitochondrial K(ATP) channels via multiple signaling pathways / Zaugg M., Lucchinetti E., Spahn D.R. // Anesthesiology. — 2014. — V. 97. — P. 4-14.
Piriou V. Pharmacological preconditioning: comparison of desflurane, sevoflurane, isoflurane and halothane in rabbit myocardium / Piriou V., Chiari P., Lhuillier F., Bastien O. // British Anaesthesiology. — 2013. — V. 89. — P. 486-491.
Marinovic J. Distinct roles for sarcolemmal and mitochondrial adenosine triphosphate-sensitive potassium channels in isoflurane-induced protection against oxidative stress / Marinovic J., Bosnjak Z.J., Stadnicka A. // Anesthesiology. — 2006. — V. 105. — P. 98-104.
Raphael J. Volatile anesthetic preconditioning attenuates myocardial apoptosis in rabbits after regional ischemia and reperfusion via Akt signaling and modulation of Bcl-2 family proteins / Raphael J., Abedat S., Rivo J., Meir K., Beeri R. // Pharmacology Experimental Therapy. — 2014. — V. 318. — P. 186-194.
Toma O. Desflurane preconditioning induces time-dependent activation of protein kinase C epsilon and extracellular signal-regulated kinase 1 and 2 in the rat heart in vivo / Toma O., Weber N.C., Wolter J.I., Obal D. // Anesthesiology. — 2013. — V. 101. — P. 1372-1380.
An J. Contribution of reactive oxygen species to isoflurane-induced sensitization of cardiac sarcolemmal adenosine triphosphate-sensitive potassium channel to pinacidil / An J., Stadnicka A., Kwok W.M., Bosnjak Z.J. // Anesthesiology. — 2012. — V. 100. — P.575-580.
Konia M.R. Nuclear factor-[kappa] B inhibition provides additional protection against ischaemia/reperfusion injury in delayed sevoflurane preconditioning / Konia M.R., Schaefer S., Liu H. // Europe Anaesthesiology. — 2015. — V. 26. — P. 496-503.
Guarracino F. Myocardial damage prevented by volatile anesthetics: a multicenter randomized controlled study / Guarracino F., Landoni G., Tritapepe L., Pompei F., Leoni A. // Cardiothoracic Vascular Anesthesiology. — 2016. — V. 20. — P. 477-483.
De Hert S.G. Cardioprotection with volatile anesthetics: mechanisms and clinical implications / De Hert S.G., Turani F., Mathur S., Stowe D.F. // Anesthesiology Analgesia. — 2014. — V. 100. — P. 1584-1593.
Bignami E. Volatile anesthetics reduce mortality in cardiac surgery / Bignami E., Biondi-Zoccai G., Landoni G., Fochi O. // Cardiothoracic Vascular Anesthesiology. — 2013. — V. 23. — P. 594-599.
Jiang M.T. Isoflurane activates human cardiac mitochondrial adenosine triphosphate-sensitive K+ channels reconstituted in lipid bilayers / Jiang M.T., Nakae Y., Ljubkovic M., Kwok W.M. // Anesthesiology Analgesia. — 2014. — V. 105. — P. 926-932.
Mio Y. Age-related attenuation of isoflurane preconditioning in human atrial cardiomyocytes: roles for mitochondrial respiration and sarcolemmal adenosine triphosphate-sensitive potassium channel activity / Mio Y., Bienengraeber M.W., Marinovic J., Gutterman D.D. // Anesthesiology. — 2014. — V. 108. — P. 612-620.
Hanouz J.L. Reactive oxygen species mediate sevoflurane- and desflurane-induced preconditioning in isolated human right atria in vitro / Hanouz J.L., Zhu L., Lemoine S., Durand C. // Anesthesiology Analgesia. — 2014. — V. 105. — P. 1534-1539.
Zangrillo A. Volatile agents for cardiac protection in noncardiac surgery: a randomized controlled study / Zangrillo A., Testa V., Aldrovandi V., Tuoro A. // Cardiothoracic Vascular ­Anesthesiology. — 2011. — V. 25. — P. 902-907.
Bassuoni A.S. Cardioprotective effect of sevoflurane in patients with coronary artery disease undergoing vascular surgery / Bassuoni A.S., Amr Y.M. // Anaesthesiology. — 2012. — V. 6. — P. 125-130.

References: V. 
 V. 
 V. 
 V. 
 V. 
 V. 
 V. 
 V. 
 V. 
 V. 
 V. 
 V. 
 V. 
 V. 
 V. 
 V. 
 V. 
 V. 
 V. 
 V. 
 V. 
 V. 
 V. 
 V. 
 V. 
 V. 
 V.