Volatile Anesthetics And Ischemia-reperfusion Injury To Organs

With the developmengt of organ transplantation and heart surgery with cardiopulmonary bypass, ischemia-reperfusion injury has become a frequant pathophysiological chang in anesthesia . Ischemia-reperfusion injury was defined as a phenomenon that under certain conditions the dysfunction of cellular metabolism and the failure of structure of some animals or patients were aggravated but not reduced. The results indicate that ischemia preconditioning may cause organs to product ischemic toleration and protect them against ischemia-reperfusion injury.In 1997,reserch shows that volatile anesthetics may also reduce organs ischemia-reperfusion injury and this protection effects was similar as ischemic preconditioning.Later, the results confirms that volatile anesthetics(i.g.halothane, isoflurane and sevoflurane)can protect myocardial, cerebral,lung and liver against ischemia-reperfusion injury.The protection effect in these organs may have some common mechanism ,but the action mechanism in each organ have its own emphosis points: To myocardial,the mechanism relates to membrane or mitochondrial ATP-sensitive potassiunm channel opening,signal transduction pathway(cell membrane receptor-inhibiting protein G-protein kinase C) activating,and protecting myocardial microvascular ;to cerebral,the mechanism includes IPC effect,reducing releasing of excitatory amino acid and monoamine transmitters ,inhibiting neurons apoptosis ,inhibiting cerebral energy metabolism and thermoregulation ; to lung,restraining permeability of alveolar capillary pressure,attenuate inflammation,reducing pulmonary vascular resistance and dilating ischemia-reperfusion-induced vasoconstriction were the main protective mechanism;and to liver,the main mechanism concludes that maintaining energy balance of hepatocellular ,reducing productiong of oxygen free radical and decreasing expression of heme ocygrnase-1 (HO-1) in hepatocellular and so on.In this review ,after a brief distruction of the basis pathophysiology of ischemia-reperfusion injury ,this review will focus on the effect mechanism of volatile anesthetics protecting myocardial, cerebral,lung and liver against ischemia-reperfusion injury.