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Seminars in Cardiothoracic and Vascular Anesthesia
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Physiology and Pharmacology of Myocardial Preconditioning and Postconditioning

Julie Huffmyer, MD

Department of Anesthesiology, University of Virginia Health Sciences System, Charlottesville, Virginia, jr5ef{at}virginia.edu

Jacob Raphael, MD

Department of Anesthesiology, University of Virginia Health Sciences System, Charlottesville, Virginia

Perioperative myocardial ischemia and infarction are not only major sources of morbidity and mortality in patients undergoing surgery but also important causes of prolonged hospital stay and resource utilization. Ischemic and pharmacological preconditioning and postconditioning have been known for more than 2 decades to provide protection against myocardial ischemia and reperfusion and limit myocardial infarct size in many experimental animal models, as well as in clinical studies. This article reviews the physiology and pharmacology of ischemic and drug-induced preconditioning and postconditioning of the myocardium with special emphasis on the mechanisms by which volatile anesthetics provide myocardial protection. Insights gained from animal and clinical studies are reviewed and recommendations given for the use of perioperative anesthetics and medications.

Key Words: myocardial infarction • reperfusion injury • cardiac surgery • volatile anesthetics

This version was published on March 1, 2009

Seminars in Cardiothoracic and Vascular Anesthesia, Vol. 13, No. 1, 5-18 (2009)
DOI: 10.1177/1089253208330709
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