Method of pharmacological myocardial preconditioning with halogen-containing anesthetics in cardiosurgical patients

• Published in: Anesteziologiia i reanimatologiia no. 5; p. 4
• Main Authors: Zadorozhnyĭ, M V, Iavorovskiĭ, A G, Ziuliaeva, T P, Isaeva, A M, Vinnitskiĭ, L I, Buniatian, A A
• Format: Journal Article
• Language: Russian
• Published: Russia (Federation) 01.09.2008
• Subjects: Anesthetics, Inhalation - administration & dosage; Anesthetics, Inhalation - therapeutic use; Extracorporeal Circulation; Female; Hemodynamics - physiology; Humans; Ischemic Preconditioning, Myocardial - methods; Isoflurane - administration & dosage; Isoflurane - therapeutic use; Male; Methyl Ethers - administration & dosage; Methyl Ethers - therapeutic use; Middle Aged; Monitoring, Intraoperative; Myocardial Reperfusion Injury - physiopathology; Myocardial Reperfusion Injury - prevention & control; Myocardial Revascularization - methods; Myoglobin - blood; Treatment Outcome; Troponin - blood; Troponin I - blood
• ISSN: 0201-7563

The purpose of the investigation was to study whether isoflurane and sevoflurane might be used for pharmacological myocardial preconditioning (PMP) in patients with coronary heart disease during myocardial revascularization on the working (Part I) and arrested (Part II) heart and to develop a possible procedure for PMP. Part I deals with the study of the effect of PMP with halogen-containing anesthetics during myocardial revascularization on the working heart. The study included 66 patients who were divided into 4 groups; 1) sevoflurane feeding was started just after anesthesia induction and it lasted until some coronary arteries were ligated; 2) sevoflurane was fed for 15 min; 3) isoflurane was used; 4) controls. The markers of myocardial lesion (troponin T, I) were measured and the incidence of perioperative myocardial ischemia and needs for inotropic support were also analyzed. Part II was dedicated to the study of the effect of PMP during myocardial revascularization under extracorporeal circulation (EC). The study covered 65 patients who were divided into 4 groups; 1) sevoflurane was administered throughout the anesthesia until the aorta was ligated; 2) it was used for 15 min before aortic ligation; 3) sevoflurane was employed only to induce anesthesia; 4) controls. The variables similar to those in Part I of the investigation were chosen to assess the results of this study. The use of sevoflurane and isoflurane reduces a risk for myocardial ischemic lesion during myocardial revascularization both under EC and on the working heart. Short-term (15-min) use of an agent before myocardial ischemia suffices for PMP to develop its effect. The effect of PMP has its duration that is 76 min, as shown by our findings.