Wu Lingzhi, Zhao Hailin, Wang Tianlong, Pac-Soo Chen, Ma Daqing
Section of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, UK.
J Anesth. 2014 Oct;28(5):740-58. doi: 10.1007/s00540-014-1805-y. Epub 2014 Mar 9.
Inhalational anesthetics-induced organoprotection has received much research interest and has been consistently demonstrated in different models of organ damage, in particular, ischemia-reperfusion injury, which features prominently in the perioperative period and in cardiovascular events. The cellular mechanisms accountable for effective organoprotection over heart, brain, kidneys, and other vital organs have been elucidated in turn in the past two decades, including receptor stimulations, second-messenger signal relay and amplification, end-effector activation, and transcriptional modification. This review summarizes the signaling pathways and the molecular participants in inhalational anesthetics-mediated organ protection published in the current literature, comparing and contrasting the 'preconditioning' and 'postconditioning' phenomena, and the similarities and differences in mechanisms between organs. The salubrious effects of inhalational anesthetics on vital organs, if reproducible in human subjects in clinical settings, would be of exceptional clinical importance, but clinical studies with better design and execution are prerequisites for valid conclusions to be made. Xenon as the emerging inhalational anesthetic, and its organoprotective efficacy, mechanism, and relative advantages over other anesthetics, are also discussed.
吸入性麻醉剂诱导的器官保护作用已引起了诸多研究关注，并且在不同的器官损伤模型中得到了持续验证，尤其是在围手术期和心血管事件中显著存在的缺血再灌注损伤模型。在过去二十年中，依次阐明了心脏、大脑、肾脏及其他重要器官实现有效器官保护的细胞机制，包括受体刺激、第二信使信号转导与放大、终效应器激活以及转录修饰。本综述总结了当前文献中发表的吸入性麻醉剂介导的器官保护中的信号通路和分子参与情况，比较并对比了“预处理”和“后处理”现象，以及各器官之间机制的异同。如果吸入性麻醉剂对重要器官的有益作用在临床环境中的人类受试者身上能够重现，那将具有极其重要的临床意义，但要得出有效的结论，还需要设计和实施更优的临床研究。同时，也讨论了新兴的吸入性麻醉剂氙气及其器官保护功效、机制以及相对于其他麻醉剂的相对优势。
