Myocardial Protection in Cardiac Surgery: Exploring the Influence of Anesthetic Agents

Abstract

This review assesses the efficacy of inhalation anesthetics and propofol in cardiac surgery, primarily focusing on their impact on myocardial protection and subsequent clinical outcomes. The review provides a concise summary of the current scientific information regarding the protective effects of inhalation anesthetics and propofol, particularly in the context of ischemia-reper fusion injury during cardiac surgery. The review delves into the mechanisms of action and discusses clinical studies comparing the 2 anesthetic strategies regarding mortality, complication rates, and length of hospital stay. Inhalation anesthetics exhibit cardioprotective properties through many mechanisms, such as preconditioning, scavenging of free radicals, and stabilizing mitochondria. Propofol demonstrates certain protective benefits but does not possess the preconditioning capability of inhalation medications. Clinical investigations yield contradictory findings, as several studies indicate enhanced outcomes with inhalation anesthetics, while others observe no substantial disparity between the 2 approaches. The cardioprotective efficacy of propofol against ischemia-reper fusion injury remains limited. While its inherent antioxidant properties offer direct myocardial protection, propofol demonstrably lacks the preco nditi oning -medi ated signaling pathways triggered by inhalation anesthetics. As a result, propofol's protective effect may be slightly inferior to preconditioning strategies, and its potential to inhibit organ -protective impact of other interventions needs further investigation. The question of which anesthetic approach offers superior myocardial protection remains debatable. Current evidence is inconclusive, potentially due to patient heterogeneity, surgical complexity, and methodological limitations of existing studies. Future research, including pharmacogenetic studies and large, welldesigned, randomized controlled trials, are necessary to provide definitive guidance on anesthetic selection for optimal myocardial protection in cardiac surgery.