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Volatile anesthetic-induced cardiac protection: molecular mechanisms, clinical aspects, and interactions with nonvolatile agents.

DEPENDING ON THE PATIENT’S individual risk profile, the likelihood of their suffering from a myocardial infarction during perioperative care is around 5%. The devastating effect of such a major cardiovascular event is tremendous, with a lethal outcome in about one-fourth of the cases. However, the perioperative setting offers unique possibilities to anticipate and cardioprotect those at risk. In 1997, Kersten et al showed that the administration of 1.0 minimum alveolar concentration (MAC) of isoflurane before myocardial ischemia/reperfusion (I/R) injury significantly reduced the resulting myocardial infarct size. The discovery of this volatile anesthetic-induced cardioprotection is one of the most fascinating findings of anesthetic research and great efforts defining the involved molecular pathways have been made. It has become clear that the interactions of complex systems rather than the activation of one specific target lead to the alleviation of I/R injury. The current review presents the molecular mechanisms of volatile anesthetic-induced cardioprotection as well as outlines interactions with common co-morbidities and co-medications. Furthermore, the resulting clinical implications and future areas of research are discussed.