Canadian Journal of Anesthesia

, Volume 49, Issue 8, pp 777–791 | Cite as

Myocardial protection by anesthetic agents against ischemia-reperfusion injury: An update for anesthesiologists

General Anesthesia



The aim of this review of the literature was to evaluate the effectiveness of anesthetics in protecting the heart against myocardial ischemia-reperfusion injury.


Articles were obtained from the Medline database (1980-, search terms included heart, myocardium, coronary, ischemia, reperfusion injury, infarction, stunning, halothane, enflurane, desflurane, isoflurane, sevoflurane, opioid, morphine, fentanyl, alfentanil sufentanil, pentazocine, buprenorphine, barbiturate, thiopental, ketamine, propofol, preconditioning, neutrophil adhesion, free radical, antioxidant and calcium).

Principal findings

Protection by volatile anesthetics, morphine and propofol is relatively well investigated. It is generally agreed that these agents reduce the myocardial damage caused by ischemia and reperfusion. Other anesthetics which are often used in clinical practice, such as fentanyl, ketamine, barbiturates and benzodiazepines have been much less studied, and their potential as cardioprotectors is currently unknown. There are some proposed mechanisms for protection by anesthetic agents: ischemic preconditioning-like effect, interference in the neutrophil/platelet-endothelium interaction, blockade of Ca2+ overload to the cytosolic space and antioxidant-like effect. Different anesthetics appear to have different mechanisms by which protection is exerted. Clinical applicability of anesthetic agent-induced protection has yet to be explored.


There is increasing evidence of anesthetic agentinduced protection. At present, isoflurane, sevoflurane and morphine appear to be most promising as preconditioning-inducing agents. After the onset of ischemia, propofol could be selected to reduce ischemia-reperfusion injury. Future clinical application depends on the full elucidation of the underlying mechanisms and on clinical outcome trials.

La protection myocardique contre les lésions d’ischémie-reperfusion par des anesthésiques: Une mise à jour pour les anesthésiologistes



Évaluer l’efficacité des anesthésiques dans la protection du cœur contre les lésions myocardiques d’ischémie-reperfusion.


Des articles ont été obtenus de la base de données Medline (1980-, les mots clefs étant heart, myocardium, coronary, ischemia, reperfusion injury, infarction, stunning, halothane, enflurane, desflurane, isoflurane, sevoflurane, opioid, morphine, fentanyl, alfentanil sufentanil, pentazocine, buprenorphine, barbiturate, thiopental, ketamine, propofol, preconditioning, neutrophil adhesion, free radical, antioxidant et calcium).

Constatations principales

La protection par des anesthésiques volatils, morphine et propofol, est relativement bien explorée. On s’accorde généralement pour dire que ces agents réduisent les lésions myocardiques causées par l’ischémie et la reperfusion. D’autres anesthésiques utilisés souvent en clinique, comme le fentanyl, la kétamine, les barbituriques et les benzodiazépines, ont été moins étudiés et leur potentiel cardioprotecteur est actuellement inconnu. On propose certains mécanismes de protection par les anesthésiques: un effet qui s’apparente à un préconditionnement, une interférence dans l’interaction entre polynucléaires neutrophiles/plaquettes-endothélium, un blocage de la surcharge de Ca2+ à l’espace cytosolique et un effet du genre antioxydant. Différents anesthésiques semblent présenter des mécanismes différents par lesquels la protection s’exerce. L’applicabilité de la protection induite par les agents anesthésiques est encore à étudier.


Il y a de plus en plus d’évidence de la protection induite par les anesthésiques. Présentement, l’isoflurane, le sévoflurane et la morphine semblent les agents inducteurs de préconditionnement les plus prometteurs. Après le début de l’ischémie, le propofol peut être choisi pour réduire les lésions d’ischémie-reperfusion. L’application clinique future repose sur la mise en lumière complète des mécanismes sous-jacents et sur des essais relatifs aux avantages cliniques.


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© Canadian Anesthesiologists 2002

Authors and Affiliations

  1. 1.Department of Anesthesiology (B1), Graduate School of MedicineChiba UniversityChibaJapan
  2. 2.Nuffield Department of AnaestheticsUniversity of OxfordOxfordUK

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