BJA Advance Access originally published online on May 14, 2004
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British Journal of Anaesthesia, 2004, Vol. 93, No. 1 21-33
© 2004 The Board of Management and Trustees of the British Journal of Anaesthesia
Myocardial injury and its prevention in the perioperative setting
1 Institute of Anaesthesiology, University Hospital Zürich, Switzerland. 2 Institute of Pharmacology and Toxicology, University of Zürich, Switzerland. 3 Nuffield Department of Anaesthetics, The John Radcliffe Hospital, Oxford, UK
*Corresponding author: Institute of Anaesthesiology, University Hospital Zürich, Rämistrasse 100, CH-8091 Zürich, Switzerland. E-mail: michael.zaugg@usz.ch
Keywords: anaesthetic techniques, inhalation; complications, myocardial ischaemia; heart, cardioprotection; hibernation; stunning
| The first 150 words of the full text of this article appear below. |
In the UK, there are 
20 000 deaths within 30 days of surgery every year, 9000 of which have a cardiac cause.93 The number of major cardiac complications is likely to be in the region of 150 000 per annum. As 60% of patients who die within 30 days of surgery suffer from coronary artery disease94 it is reasonable to assume that the majority of cardiac complications of anaesthesia and surgery results from myocardial ischaemia leading to myocardial injury (Fig. 1).
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Myocardial responses to ischaemia
Acute myocardial ischaemia
Mechanisms of myocardial ischaemia
Myocardial stunning (flow-contractility mismatch)
Mechanisms of myocardial stunning
Myocardial hibernation
Mechanisms of myocardial hibernation
Myocardial preconditioning
Mechanisms of myocardial preconditioning
Role of adenosine
Role of bradykinin
Role of opioids
Role of adrenergic receptors
Role of free oxygen radicals and nitric oxide
Calcium ions
Protein kinase C (PKC)
Role of ATP-dependent potassium channels (KATP channels)
Other beneficial effects associated with cardiac preconditioning
Late preconditioning
Remote preconditioning
Protective effects of anaesthetics against ischaemia
Anaesthetics and myocardial stunning
Anaesthetics and cardiac preconditioning
Isoflurane
Sevoflurane
Desflurane
Pharmacological interventions by nonanaesthetic agents currently used for the prevention of perioperative ischaemia
Nitroglycerin
Calcium channel blockers
Adenosine modulators
2-Adrenoceptor agonists
Nicorandil
Statins
ß-Blockers
Conclusions
Acknowledgements
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