PHARMACOLOGICAL CARDIAC PROTECTION: WHAT IS NEW?
https://doi.org/10.21292/2078-5658-2019-16-2-57-66
Abstract
The lecture is devoted to the current state of pharmacological cardiac protection in patients with a high cardiac risk undergoing non-cardiac and cardiac surgery with cardiopulmonary bypass. It describes the main etiopathogenetic mechanisms of ischemic reperfusion myocardial damage. The possible cardioprotection mechanisms when using inhalation anesthetics, β-adrenoreceptor blocking agents, calcium channel blockers, statins, nitrates, α2 -agonists, ACE inhibitors and sartans, levosimendan, phosphocreatine, and glucose-insulin-potassium mixture are analyzed. New research data are reviewed, including recent meta-analyses and extensive randomized studies aimed to assess the efficacy of the above medicines. It presents contemporary clinical guidelines on the use of pharmacological cardioprotection in various clinical situations. It has been concluded that the range of drugs recommended for cardioprotection is constantly changing in accordance with latest data, and updating the scientific information on this issue is an important to improve the professional competence of anesthesiologists and emergency physicians.
About the Author
I. A. Kozlov
M.F. Vladimirsky Moscow Regional Research Clinical Institute
Russian Federation
Russian Federation
Doctor of Medical Sciences, Professor, Professor of Anesthesiology and Intensive Care Faculty for Doctor's Professional Development,
Build. 15, 61/2, Schepkina St., Moscow, 129110
References
1. Zabolotskikh I.B., Lebedinskiy K.M., Grigoriev E.V. et al. Perioperatsionnoe vedenie bolnykh s soputstvuyuschey ishemicheskoy boleznyu serdtsa. Klinicheskie rekomendatsii. V knige: Аnesteziologiya-reanimatologiya. Klinicheskie rekomendatsii. [Peri-operative management of the patients with concurrent ischemic heart disease. Clinical recommendations. In: Anesthesiology and Intensive care. Clinical recommendations]. I.B. Zabolotskikh, E.M. Shifman, eds., Moscow, GEOTAR-Media Publ., 2016, pp. 54-89.
2. Kozlov I.А., Klypa T.V. Glucose-insulin mixture as a cardiac protector in cardiology and cardiac surgery (review). Obschaya Reanimatologiya, 2017, vol. 13, no. 1, pp. 57-72. (In Russ.) doi: 10.15360/1813-9779-2017-1-57-72.
3. Kozlov I.А., Klypa T.V., Аntonov I.O. Dexmedetomidine as a cardiac protector in cardiac surgery (review). Obschaya Reanimatologiya, 2017, vol. 13, no. 4, pp. 46-63. (In Russ.) doi: 10.15360/1813-9779-2017-4-46-63
4. Kozlov I.А., Krichevskiy L.А. Evaluation of levosimendan efficacy in cardiac surgery. Vestnik Anesteziologii I Reanimatologii, 2017, vol. 14, no. 4, pp. 81-82. (In Russ.) doi: 10.21292/2078-5658-2017-14-4-81-82.
5. Kozlov I.А., Yavorovskiy А.G. Exogenous phosphocreatine as a cardiac protectors in surgery and intensive cardiology. Analytic review. Meditsinsky Alfavit. 2018, vol. 1, no. 9, pp. 18-27. (In Russ.)
6. Lomivorotov V.V., Efremov S.M., Аbubakirov M.N. et al. Is it worth to discontinue drugs blocking the activity of renin-angiotensin-aldosterone system in the peri-operative period? Vestnik Anesteziologii I Reanimatologii, 2018, vol. 15, no. 3, pp. 56-61. (In Russ.) doi: 10.21292/2078-5658-2018-15-3-56-61
7. Lomivorotov V.V., Efremov S.M., Аbubakirov M.N. et al. Should statins be discontinued in the peri-operative period? Vestnik Anesteziologii I Reanimatologii, 2018, vol. 15, no. 4, pp. 86-90. (In Russ.) doi: 10.21292/2078-5658-2018-15-4-86-90
8. Molchan N.S., Polushin Yu.S., Zhloba А.А. et al. Impact of anesthesia with prolonged use of desflurane and sevoflurane on the cardiac function in coronary artery bypass graft surgeries with cardiopulmonary bypass. Vestnik Anesteziologii I Reanimatologii, 2017, vol. 14, no. 4, pp. 23-31. (In Russ.) doi: 10.21292/2078-5658-2017-14-4-23-31.
9. Ovezov А.M., Kozlov I.А. Perioperatsionnye kardialnye oslozhneniya (povrezhdenie miokarda, serdechnaya nedostatochnost) v nekardialnoy khirurgii. Uchebno-metodicheskoe posobie. [Peri-operative cardiac compications (myocardial injury, heart failure) in non-cardiac surgery. Handbook]. Moscow Regional Research Clinical Institute named after M.F. Vladimirsky, Moscow, OOO RIA PharmEtika Publ., 2019, 71 p.
10. ESC/EACTS work group on myocardial revascularization. 2014 ESC/EACTS Guidelines on myocardial revascularization. Rossiysky Kardiologicheskiy Journal, 2015, vol. 118, no. 2, pp. 5-81. (In Russ.)
11. Chepurnyak E.Yu., Panov А.V., Lokshin L.S. Use of inhalation anesthetics during cardiopulmonary bypass. Vestnik Anesteziologii I Reanimatologii, 2018, vol. 15, no. 4, pp. 70-75. (In Russ.) doi: 10.21292/2078-5658-2018-15-4-70-75. 12.
12. de Hert S., Moerman A. Anesthetic preconditioning: have we found the holy grail of perioperative cardioprotection? J. Cardiothorac. Vasc. Anesth., 2018, vol. 32, no. 3, pp. 1135-1136. doi: 10.1053/j.jvca.2018.01.001.
13. Duncan D., Sankar A., Beattie W.S. et al. Alpha-2 adrenergic agonists for the prevention of cardiac complications among adults undergoing surgery. Cochrane Database Syst Rev., 2018, 3:CD004126. doi: 10.1002/14651858. CD004126.pub3.
14. Ellenberger C., Sologashvili T., Kreienbühl L. et al. Myocardial protection by Glucose-Insulin-Potassium in moderate - to high-risk patients undergoing elective on-pump cardiac surgery: a randomized controlled trial. Anesth. Analg., 2018, vol. 126, no. 4, pp. 1133-1141. doi: 10.1213/ANE.0000000000002777.
15. Gilbert-Kawai E., Montgomery H. Cardiovascular assessment for non-cardiac surgery: European guidelines. Br. J. Hosp. Med. (Lond), 2017, vol. 78, no. 6, pp. 327-332. doi: 10.12968/hmed.2017.78.6.327.
16. Pagel P.S., Crystal G.J. The discovery of myocardial preconditioning using volatile anesthetics: a history and contemporary clinical perspective. J. Cardioth. Vasc. Anesth., 2018, vol. 32, no. 3, pp. 1112–1134. doi:10.1053/j.jvca.2017.12.029.
17. Santillo E., Migale M., Postacchini D. et al. Cardioprotection by Conditioning Mimetic Drugs. Antiinflamm Antiallergy Agents Med. Chem., 2016, vol. 15, no. 1, pp. 15-30. doi: 10.2174/1871523015666160719155122.
18. Thygesen K., Alpert J.S., Jaffe A.S. et al. Fourth universal definition of myocardial infarction (2018). Eur. Heart J., 2019, vol. 40, no. 3, pp. 237-269. doi: 10.1093/eurheartj/ehy462.
19. Wagner R., Piler P., Gabbasov Z. et al. Adjuvant cardioprotection in cardiac surgery: update. Biomed Res Int., 2014, 2014:808096. doi: 10.1155/2014/808096.
Review
For citations:
Kozlov I.A. PHARMACOLOGICAL CARDIAC PROTECTION: WHAT IS NEW? Messenger of ANESTHESIOLOGY AND RESUSCITATION. 2019;16(2):57-66. (In Russ.) https://doi.org/10.21292/2078-5658-2019-16-2-57-66
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