Physiology and Pharmacology of Myocardial Preconditioning and Postconditioning
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Abstract:
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.Keywords:
Ischemic Preconditioning
Clinical Pharmacology
Myocardial Reperfusion Injury
Myocardial ischemia and reperfusion injury are important clinical problems. This paper discusses recent developments in myocardial protection over the past year, focussing on cellular mechanisms for reperfusion injury and controversies in cardioplegic techniques.
Myocardial Reperfusion Injury
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The occurrence of myocardial ischaemia will result in either reversible or irreversible myocardial dysfunction. Even when revascularization is successful, some reperfusion injury may occur that transiently impairs myocardial function. Therefore, treatment should not only be directed towards prompt restoration of myocardial blood flow but measures should also be taken to prevent or alleviate the consequences of myocardial reperfusion injury. Over the years, various strategies have been developed. The present contribution reviews a number of these strategies focusing on pharmacological treatments that have been developed to address myocardial reperfusion injury.
Myocardial Revascularization
Myocardial Reperfusion Injury
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Objective To investigate the incidence of perioperative myocardial ischemia to give anesthesiologists support for dealing with the perioperative myocardial ischemia. Methods 446 myocardial ischemic patients were selected from 6000 preoperative patients in SHENG JING Hospital of China Medical University. Their ECG、changes of circulating parameters and the end-results were observed. The proportion of perioperative myocardial ischemia at each age and the end-results of perioperative myocardial ischemic patients were evaluated with statistical methods. Results There were 446 myocardial ischemic patients in 6000 preoperative patients; 392 myocardial ischemic patients were 50 years old or older,while 54 myocardial ischemic patients younger than 50 years old. 48 patients were sent to ICU ward because of circulatory parameters fluctuation or respiratory system insufficiency. Conclusion The perioperative myocardial ischemia occurred more frequently in the patients over 50 years old,with higher proportion of complicated high blood pressure and diabetes. Circulatory parameters such as BP and HR fluctuate more in general anesthesia in this group of patients. Therefore,it is of great importance to evaluate their preoperative condition carefully,give sufficient preoperative preparation and strict perioperative management.
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Hypoxia
Myocardial Reperfusion Injury
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Myocardial reperfusion injury and myocardial hypertrophy are two important factors of causing myocardial cell injury,the Modern clinical studies and animal experiments has proved that panax notoginseng is able to protect from these injuries exactly.Panax Notoginseng Saponins produces many regulations and implements its protective effect by promoting or inhibiting the expressions of different activity factors and related signal transductions at molecular and neurohumor aspects.This article reviewed the research advance in the protection effect and mechanism of panax notoginseng saponins on myocardial reperfusion injury and myocardial hypertrophy.
Panax notoginseng
Myocardial hypertrophy
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Discusstion on the role of the possible mechanism with myocardial ischemia and reperfusion injury by ShenFu injection to protect.The protective of ShenFu injection to myocardial ischemia reperfusion injury are multifactor through various ways,in order to provide some clinical research.
Myocardial Reperfusion Injury
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Ischemic preconditioning (IPC) is a phenomenon during which myocardium, subjected to brief episodes of ischemia followed by reperfusion, tolerates better the subsequent, more prolonged episode of this ischemia followed by reperfusion. Its signal transduction pathways involve trigger-mediators-effectors. Through effectors, IPC protects myocardium by reperfusion.
Cardioprotection
Ischemic Preconditioning
Myocardial Reperfusion Injury
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