Dost Burhan, Turunc Esra, Sarikaya Ozel Elif, Aydın Muhammed Enes, Karapinar Yunus Emre, Beldagli Muzeyyen, De Cassai Alessandro
Department of Anaesthesiology and Reanimation, Ondokuz Mayıs University Faculty of Medicine, Samsun, Türkiye.
Department of Anesthesiology and Reanimation, Atatürk University Faculty of Medicine, Erzurum, Türkiye.
Eurasian J Med. 2023 Dec;55(1):138-141. doi: 10.5152/eurasianjmed.2023.23376.
This review assesses the efficacy of inhalation anesthetics and propofol in cardiac surgery, primarily focusing on their impact on myocardial protection and subsequent clinical outcomes. The review provides a concise summary of the current scientific information regarding the protective efects of inhalation anesthetics and propofol, particularly in the context of ischemia-reperfusion injury during cardiac surgery. The review delves into the mechanisms of action and discusses clinical studies comparing the 2 anesthetic strategies regarding mortality, complication rates, and length of hospital stay. Inhalation anesthetics exhibit cardioprotective properties through many mechanisms, such as preconditioning, scavenging of free radicals, and stabilizing mitochondria. Propofol demonstrates certain protective benefits but does not possess the preconditioning capability of inhalation medications. Clinical investigations yield contradictory findings, as several studies indicate enhanced outcomes with inhalation anesthetics, while others observe no substantial disparity between the 2 approaches. The cardioprotective efcacy of propofol against ischemia-reperfusion injury remains limited. While its inherent antioxidant properties ofer direct myocardial protection, propofol demonstrably lacks the preconditioning-mediated signaling pathways triggered by inhalation anesthetics. As a result, propofol's protective efect may be slightly inferior to preconditioning strategies, and its potential to inhibit organ-protective impact of other interventions needs further investigation. The question of which anesthetic approach ofers superior myocardial protection remains debatable. Current evidence is inconclusive, potentially due to patient heterogeneity, surgical complexity, and methodological limitations of existing studies. Future research, including pharmacogenetic studies and large, welldesigned, randomized controlled trials, are necessary to provide definitive guidance on anesthetic selection for optimal myocardial protection in cardiac surgery.
本综述评估了吸入麻醉剂和丙泊酚在心脏手术中的疗效，主要关注它们对心肌保护及后续临床结果的影响。该综述简要总结了当前有关吸入麻醉剂和丙泊酚保护作用的科学信息，特别是在心脏手术期间缺血再灌注损伤的背景下。综述深入探讨了作用机制，并讨论了比较这两种麻醉策略在死亡率、并发症发生率和住院时间方面的临床研究。吸入麻醉剂通过多种机制表现出心脏保护特性，如预处理、清除自由基和稳定线粒体。丙泊酚显示出一定的保护益处，但不具备吸入药物的预处理能力。临床研究结果相互矛盾，一些研究表明吸入麻醉剂能改善结果，而另一些研究则未观察到这两种方法之间存在实质性差异。丙泊酚对缺血再灌注损伤的心脏保护疗效仍然有限。虽然其固有的抗氧化特性可提供直接的心肌保护，但丙泊酚显然缺乏吸入麻醉剂触发的预处理介导的信号通路。因此，丙泊酚的保护作用可能略逊于预处理策略，其抑制其他干预措施器官保护作用的潜力需要进一步研究。哪种麻醉方法能提供更好的心肌保护这一问题仍存在争议。目前的证据尚无定论，这可能是由于患者异质性、手术复杂性以及现有研究的方法学局限性所致。未来的研究，包括药物遗传学研究以及大型、设计良好的随机对照试验，对于为心脏手术中最佳心肌保护的麻醉选择提供明确指导是必要的。
