Cardioprotective anesthesia in patients undergoing coronary surgery: fact or fiction?

The use of volatile anesthetics in patients undergoing coronary artery bypass grafting resulted in a shorter length of stay (LOS) in the intensive care unit, shorter LOS in the hospital, and a decreased need for prolonged intensive care. Volatile anesthetics exert cardioprotective effects by anesthetic preconditioning in patients at risk of myocardial ischemia. Sarcolemmal and mitochondrial ATP-dependent potassium channels are the key for anesthetic preconditioning. However, no clinical study has shown that the perioperative use of volatile anesthetics in patients undergoing coronary surgery contributes to a reduced perioperative mortality. For the first time, the study from De Hert and colleagues clearly demonstrates that inhalational anesthesia results in a reduced perioperative cardiac morbidity. In the authors opinion, cardioprotection by activation of ATP-dependent potassium channels will become part of any cardiac revascularization procedure in the future.