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Continuing Education in Anaesthesia, Critical Care & Pain Advance Access originally published online on May 4, 2009
Continuing Education in Anaesthesia, Critical Care & Pain 2009 9(3):97-101; doi:10.1093/bjaceaccp/mkp011
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© The Author [2009]. Published by Oxford University Press on behalf of The Board of Directors of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournal.org

Perioperative myocardial protection

Timothy Scott, MRCP FRCA
Specialist Registrar
Department of Anaesthesia and Critical Care
University Hospitals of Leicester NHS Trust
Leicester LE3 9QP
UK

Justiaan Swanevelder, MBChB MMed (Anaes) FCA (SA) FRCA
Consultant Anaesthetist
Department of Anaesthesia and Critical Care
Glenfield Hospital
University Hospitals of Leicester NHS Trust
Leicester LE3 9QP
UK
Tel: +44 116 2503454
Fax: +44 116 2314791
E-mail: justiaan.swanevelder@uhl-tr.nhs.uk (for correspondence)

The first 150 words of the full text of this article appear below.


Key points

Myocardial protection refers to all strategies that increase the heart's ability to withstand an ischaemic insult.
Stunning is potentially life-threatening post-ischaemic myocardial impairment after blood flow is fully restored.
Hibernation is a prolonged state of reduced myocardial contractility in response to arterial insufficiency such that oxygen demand matches oxygen supply.
Volatile anaesthetic agents possess cardioprotective properties independent of their beneficial effect on myocardial oxygen balance.
There is good evidence that perioperative use of β-blockers, statins, and {alpha}2-agonists reduce perioperative myocardial mortality.

 

Myocardial protection refers to all strategies that increase the heart's ability to withstand ischaemic insult, which together with reperfusion injury are principally responsible for cardiac morbidity and mortality after high-risk surgery. The bloodless and motionless operating conditions required for cardiac surgery is an environment diametrically opposed to the metabolic demands of the heart.


   Pathophysiology of myocardial reperfusion
 
Ischaemia of sufficient duration results in cell death. However, should the ischaemic insult be . . . [Full Text of this Article]


   Temperature and haemodynamic modulation
 

   Cardioplegic techniques
 

   Ischaemic preconditioning
 

   Anaesthetic preconditioning
 

   Postconditioning and remote ischaemic preconditioning
 

   Pharmacotherapy
 

   Other strategies
 

   Conclusion
 

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