Landoni G, Fochi O, Tritapepe L, Guarracino F, Belloni I, Bignami E, Zangrillo A
Department of Cardiothoracic Anesthesia and Intensive Care, Vita-Salute San Raffele University, Milan, Italy.
Minerva Anestesiol. 2009 May;75(5):269-73. Epub 2008 Nov 6.
All volatile anesthetics have cardiac depressant effects that decrease myocardial oxygen demand and may thus improve the myocardial oxygen balance during ischemia. Recent experimental evidence has clearly demonstrated that, in addition to these indirect effects, volatile anesthetic agents also directly protect from ischemic myocardial damage. Implementation of these effects during clinical anesthesia can provide an additional tool for treatment or prevention of ischemic cardiac dysfunction during the perioperative period. A recent meta-analysis showed that desflurane and sevoflurane reduce postoperative mortality and the incidence of myocardial infarction following cardiac surgery, with significant advantages in terms of postoperative cardiac troponin release, need for inotropic support, and time on mechanical ventilation, as well as in time spent in the intensive care unit and overall hospital stay. Multicenter, randomized clinical trials previously demonstrated that desflurane could reduce the postoperative release of cardiac troponin I, the need for inotropic support, and the number of patients requiring prolonged hospitalization following coronary artery bypass graft surgery, either with or without cardiopulmonary bypass. However, evidence in non-coronary surgical settings is contradictory and will be reviewed in this paper, together with the mechanism of cardiac protection by volatile agents.
所有挥发性麻醉剂都具有心脏抑制作用，可降低心肌氧需求，从而可能改善缺血期间的心肌氧平衡。最近的实验证据清楚地表明，除了这些间接作用外，挥发性麻醉剂还能直接保护心肌免受缺血性损伤。在临床麻醉期间实施这些作用可为围手术期治疗或预防缺血性心脏功能障碍提供额外的手段。最近的一项荟萃分析表明，地氟烷和七氟烷可降低心脏手术后的术后死亡率和心肌梗死发生率，在术后心肌肌钙蛋白释放、使用血管活性药物支持的需求、机械通气时间以及在重症监护病房的时间和总体住院时间方面具有显著优势。多中心随机临床试验此前表明，无论是否进行体外循环，地氟烷均可减少冠状动脉搭桥手术后心肌肌钙蛋白I的术后释放、血管活性药物支持的需求以及需要延长住院时间的患者数量。然而，非冠状动脉手术环境中的证据相互矛盾，本文将对其进行综述，并探讨挥发性药物的心脏保护机制。
