Volatile anesthetics and cardiac function.

All volatile anesthetics have been shown to induce a dose-dependent decrease in myocardial contractility and cardiac loading conditions. These depressant effects decrease myocardial oxygen demand and may, therefore, have a beneficial role on the myocardial oxygen balance during myocardial ischemia. Recently, experimental evidence has clearly demonstrated that in addition to these indirect protective effects, volatile anesthetic agents also have direct protective properties against reversible and irreversible ischemic myocardial damage. These properties have not only been related to a direct preconditioning effect but also to an effect on the extent of reperfusion injury. The implementation of these properties during clinical anesthesia can provide an additional tool in the treatment or prevention, or both, of ischemic cardiac dysfunction in the perioperative period. In the clinical practice, these effects should be associated with improved cardiac function, finally resulting in a better outcome in patients with coronary artery disease. The potential application of these protective properties of volatile anesthetic agents in clinical practice is the subject of ongoing research. This review summarizes the current knowledge on this subject.