STRATEGIJA I PERSPEKTIVA ZAŠTITE MIOKARDA TOKOM ISHEMIJE I REPERFUZIJE I ULOGA INHALACIONIH ANESTETIKA

Abstract

Surgical coronary revascularization is based on effectiveness of cardioplegia directed to protect myocardial functional integrity during periods of ischaemia and reperfusion. The aim of cardioplegia is to protect numerous intracellular processes: to spare the intracellular energy stores, to reduce free oxygen radical synthesis, to protect the function of the endothelium and myocardial oxygen balance as well as ionic balance. Crystalloid or blood cardioplegia, with anterograde or retrograde infusion, is a basic procedure of the intraoperative cardiac protection. Glucose-insulin-potassium (GIK) solution was primarily used in myocardial infarction. After the first promising results, some surgical teams started using a high glucose-insulin-potassium solution, as a metabolic modulation approach, during coronary surgery in addition to cardioplegia. The improvement of the left ventricular performances, rare rhythm disturbances and reduced need for inotropic support during the period of reperfusion justified the GIK beneficial effect. Further improvement in metabolic modulation during coronary surgery was made with fluorine ion halogenated volatile aneasthetics used for anaesthesia. Results of some experimental and first clinical studies have induced a new approach to modulation of the intracellular metabolic mechanisms and announced the new concept of anaesthetic preconditioning in coronary surgery. Large, randomized studies are needed to evaluate anaesthetic preconditioning and dependence of its efficiency on the type and dose of volatile anaesthetics.

Keywords: cardioprotection; volatile anaesthetics; coronary surgery