Van Allen Nicole R, Krafft Paul R, Leitzke Arthur S, Applegate Richard L, Tang Jiping, Zhang John H
Department of Physiology, Loma Linda University School of Medicine, Risley Hall, Room 223, Loma Linda, CA 92354, USA.
Med Gas Res. 2012 Aug 28;2(1):22. doi: 10.1186/2045-9912-2-22.
This review evaluates the mechanism of volatile anesthetics as cardioprotective agents in both clinical and laboratory research and furthermore assesses possible cardiac side effects upon usage. Cardiac as well as non-cardiac surgery may evoke perioperative adverse events including: ischemia, diverse arrhythmias and reperfusion injury. As volatile anesthetics have cardiovascular effects that can lead to hypotension, clinicians may choose to administer alternative anesthetics to patients with coronary artery disease, particularly if the patient has severe preoperative ischemia or cardiovascular instability. Increasing preclinical evidence demonstrated that administration of inhaled anesthetics - before and during surgery - reduces the degree of ischemia and reperfusion injury to the heart. Recently, this preclinical data has been implemented clinically, and beneficial effects have been found in some studies of patients undergoing coronary artery bypass graft surgery. Administration of volatile anesthetic gases was protective for patients undergoing cardiac surgery through manipulation of the potassium ATP (KATP) channel, mitochondrial permeability transition pore (mPTP), reactive oxygen species (ROS) production, as well as through cytoprotective Akt and extracellular-signal kinases (ERK) pathways. However, as not all studies have demonstrated improved outcomes, the risks for undesirable hemodynamic effects must be weighed against the possible benefits of using volatile anesthetics as a means to provide cardiac protection in patients with coronary artery disease who are undergoing surgery.
本综述评估了挥发性麻醉剂在临床和实验室研究中作为心脏保护剂的作用机制，并进一步评估了使用过程中可能出现的心脏副作用。心脏手术和非心脏手术都可能引发围手术期不良事件，包括：缺血、各种心律失常和再灌注损伤。由于挥发性麻醉剂具有可导致低血压的心血管效应，临床医生可能会选择为冠心病患者使用其他麻醉剂，特别是如果患者术前存在严重缺血或心血管不稳定的情况。越来越多的临床前证据表明，在手术前和手术期间给予吸入麻醉剂可减轻心脏的缺血和再灌注损伤程度。最近，这一临床前数据已应用于临床，并且在一些冠状动脉搭桥手术患者的研究中发现了有益效果。挥发性麻醉气体的给药通过操纵三磷酸腺苷钾（KATP）通道、线粒体通透性转换孔（mPTP）、活性氧（ROS）生成以及通过细胞保护的Akt和细胞外信号激酶（ERK）途径，对接受心脏手术的患者具有保护作用。然而，由于并非所有研究都证明了预后改善，对于正在接受手术的冠心病患者，必须权衡使用挥发性麻醉剂提供心脏保护的可能益处与不良血流动力学效应的风险。
