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Halogenated Agents and Cardiovascular Surgery: Has Mortality Really Decreased?

[ Vol. 16 , Issue. 4 ]

Author(s):

Giovanni Landoni*, Juan Carlos Lopez-Delgado, Chiara Sartini, Simona Tamà and Alberto Zangrillo   Pages 336 - 343 ( 8 )

Abstract:


Halogenated anesthetic agents (desflurane, isoflurane and sevoflurane) may have cardioprotective properties at therapeutic doses against myocardial intraoperative ischemia-reperfusion injury. Cardioprotection mechanisms are related to mitochondrial and anti-apoptotic signaling pathways. Experimentals and human studies have proven that their use may reduce morbidity and mortality in the setting of cardiac surgery, including a reduction in myocardial infarct size and mechanical ventilation needs. In contrast, total intra-venous propofol based anesthesia may be detrimental. In the present review, we show the rationale for the perioperative use of halogenated anesthetics based on mechanisms of action, experimental research and human studies. Considerations and major concerns regarding their use, the present evidence for their use in other areas, such as major non-cardiac surgery and intensive care unit patients, and future perspectives are also discussed.

Keywords:

Halogenated agents, total intra-venous anesthesia, cardiac surgery, outcomes, intensive care unit, anesthesia, intensive care.

Affiliation:

Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Intensive Care Department, Hospital Universitari de Bellvitge, L`Hospitalet de Llobregat, Barcelona, Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan

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