Cardioprotection with Anesthetic Agents: Myth or Reality?

With the aging of the population, anesthesiologists are increasingly treating patients with ischemic heart disease. The presence or development of myocardial ischemia may be an important cause of perioperative complications. A recent study analyzed the incidence of complications in 3970 patients aged ≥50 years who were scheduled for major noncardiac procedures. 1 Cardiac complications occurred in 2%, while noncardiac complications occurred in 13%. In addition, patients with cardiac complications were more likely to suffer noncardiac compli- cations than those without cardiac complications (odds ratio = 6.4; 95 % confi- dence interval (CI), 3.9-10.6). Conversely, patients with noncardiac complications were more likely to suffer cardiac complications than those without complications (odds ratio = 5.3; 95 % CI, 3.2 - 8.8). The occurrence of both cardiac and noncar- diac complications was associated with a markedly increased length of hospital stay (11 vs 4 days). Preventing and/or treating myocardial ischemic events is there- fore an integral part of the anesthesiologist's job. This issue of Anesthesiology Rounds provides insight into the mechanisms involved in myocardial ischemia and the potential therapeutic approaches that are mandatory for professionals involved in the perioperative care of patients. ISCHEMIA-REPERFUSION INJURY