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Canadian Journal of Anesthesia 49:777-791 (2002)
© Canadian Anesthesiologists' Society, 2002
General Anesthesia

Myocardial protection by anesthetic agents against ischemia-reperfusion injury: an update for anesthesiologists

[La protection myocardique contre les lésions d’ischémie-reperfusion par des anesthésiques : une mise à jour pour les anesthésiologistes]

Rie Kato, MD DPHIL* and Pierre Foëx, MD DPHIL{dagger}

* From the Department of Anesthesiology (B1), Graduate School of Medicine, Chiba University, Chiba, Japan, and
{dagger} the Nuffield Department Of Anaesthetics University of Oxford, Oxford, United Kingdom.

Dr. Rie Kato, Department of Anesthesiology (B1), Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan. Phone: +81 43-2262155; Fax: +81 43-2262156; E-mail: rie.kato{at}anesth01.m.chiba-u.ac.jp

Objectif: Évaluer l’efficacité des anesthésiques dans la protection du coeur contre les lésions myocardiques d’ischémie-reperfusion.

Source : Des articles ont été obtenus de la base de données Medline (1980-, les mots clefs étant heart, myocardium, coronary, ischemia, reperfusion injury, infarction, stunning, halothane, enflurane, desflurane, isoflurane, sevoflurane, opioid, morphine, fentanyl, alfentanil sufentanil, pentazocine, buprenorphine, barbiturate, thiopental, ketamine, propofol, preconditioning, neutrophil adhesion, free radical, antioxidant et calcium).

Constatations principales : La protection par des anesthésiques volatils, morphine et propofol, est relativement bien explorée. On s’accorde généralement pour dire que ces agents réduisent les lésions myocardiques causées par l’ischémie et la reperfusion. D’autres anesthésiques utilisés souvent en clinique, comme le fentanyl, la kétamine, les barbituriques et les benzodiazépines, ont été moins étudiés et leur potentiel cardioprotecteur est actuellement inconnu. On propose certains mécanismes de protection par les anesthésiques : un effet qui s’apparente à un préconditionnement, une interférence dans l’interaction entre polynucléaires neutrophiles/plaquettes-endothélium, un blocage de la surcharge de Ca2+ à l’espace cytosolique et un effet du genre antioxydant. Différents anesthésiques semblent présenter des mécanismes différents par lesquels la protection s’exerce. L’applicabilité de la protection induite par les agents anesthésiques est encore à étudier.

Conclusion : Il y a de plus en plus d’évidence de la protection induite par les anesthésiques. Présentement, l’isoflurane, le sévoflurane et la morphine semblent les agents inducteurs de préconditionnement les plus prometteurs. Après le début de l’ischémie, le propofol peut être choisi pour réduire les lésions d’ischémie-reperfusion. L’application clinique future repose sur la mise en lumière complète des mécanismes sous-jacents et sur des essais relatifs aux avantages cliniques.




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This Article
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