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Signa Vitae

Journal of Intensive Care and Emergency Medicine

Cardioprotective Effect of Sevoflurane in Patients Undergoing Coronary Artery Bypass Grafting

Background

The cardioprotective effect of sevoflurane have been proven in experimental and clinical studies. However, it has not been studied so far if this effect on the myocardium is more expressed before the onset of myocardial ischaemia (preconditioning) or after (postconditioning). The aim of this study was to determine whether the cardioprotective effect of sevoflurane was more expressed during the preconditioning or postconditioning phase of coronary bypass grafting operations.

Key words: cardioprotective effect, sevoflurane, volatile anaesthetics, myocardial ischaemia, preconditioning, postconditioning

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Levosimendan in acute heart failure

Abstract

Numerous adverse effects and an increased mortality are the reasons why many clinicians are often unsuccessful with the inotropic agents presently in use. New therapeutic agents have been developed in the last few years to assist the clinician in the stabilization, support and treatment of cardiovascular disease.
One of the newest groups of inotropic agents is a group of agents, which increase the affinity of myofibrils for calcium and are called calcium sensitizers. Calcium sensitizers are the newest heterogeneous group of inotropic agents. The best known representatives of this group are levosimendan and pimobendan. Positive inotropic effects of levosimendan are achieved by its binding to troponin C and calcium, thereby stabilizing the tropomyosin molecule and prolonging the duration of actinmyosin overlap without a change in the net concentration of intracellular calcium. The vasodilatory effect of levosimendan is reached through activation of ATP-dependent potassium channels. This leads to a decrease in both afterload and preload, increased coronary blood flow and a resultant anti-ischemic effect. Levosimendan is therefore categorized as an antiischemic inotropic agent. Furthermore, experiments have confirmed that levosimendan as an opener of KATP – channels in the mitochondria and the sarcolemma of myocites may have an effect on the myocardium preconditioning

Key words: levosimendan, inotropic state, preconditioning, low cardiac output syndrome

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Anesthetics and cardioprotection

Abstract

The prevalence of the cardiovascular disease significantly affects the outcome of both cardiac and non-cardiac surgery, and perioperative cardiac morbidity is one of the leading causes of death following anesthesia and surgery. The considerable incidence of myocardial infarction, congestive heart failure, myocardial ischemia, or serious dysrhythmias during the intraoperative or postoperative periods, has led many studies to examine medical factors and interventions for decreasing cardiac risk in patients with cardiovascular disease. An extensive amount of work has focused on whether any one anesthetic agent or technique is particularly beneficial for patients with coronary artery disease. Experimental studies conducted in our laboratory have clearly shown that volatile anesthetics may exert profound cardioprotection against myocardial ischemia and reperfusion injury. This article examines the recent evidence about the importance of mitochondria, reactive oxygen species and the KATP channels in cardioprotective signaling by volatile anesthetics. Moreover, the article addresses current concepts and controversies regarding specific roles of the mitochondrial and the sarcolemmal KATP channels in anesthetic-induced preconditioning.

Key words: preconditioning, volatile anesthetics, heart, coronary disease, ischemia, myocardial infarction, mitochondria.

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