While halogenated anesthetics provide known cardioprotective effects via mitochondrial and antiapoptotic pathways during cardiac surgery, their specific biological mechanisms when administered during extracorporeal circulation remain largely unknown and require further study.
No change to anesthetic practice during ECC; leaves open mechanistic studies of halogenated agents in cardiac surgery.
The implementation of cardioprotective strategies involving pre-, intra-, and postoperative interventions is key during cardiac surgery requiring extracorporeal circulation (ECC). The primary goal of this study was to review the physiopathology and protection strategies against myocardial damage secondary to ECC during cardiac surgery. The administration halogenated anesthetics for cardiac anesthesia is common place due to their well-known cardioprotective effects and their capacity to ensure hypnosis. An optimal myocardial protection strategy requires that a comprehensive approach should be adopted to cover pre-, intra-, and post-operative interventions. Pre-conditioning and post-conditioning share numerous pathways, mainly based on mitochondrial signaling, antiapoptotic pathways, and reduced inflammatory mediators. However, volatile anesthetic can also be administered during ECC, in which mechanism of action has been scantly investigated, during this period and its biology is still unknown.
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Ramírez-Aliaga et al. (2017) studied this question.
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