oa Southern African Journal of Anaesthesia and Analgesia - Ischaemic preconditioning - the molecular mechanisms andthe influence of general anaesthesia : SASA 2009 Congress prize entries



The modern anaesthetist is in a privileged position to favourably influence cardiac outcomes during surgery. Poor myocardial protection rather than inadequate anatomical repair is recognised as the primary determinant of low cardiac output after cardiac bypass. The phenomenon of ischaemic preconditioning and more recently post-conditioning, is known to increase the heart's resistance to ischaemic insults. Ideally, the physician would like to activate the intracellular mechanisms instrumental in bringing about ischaemic preconditioning by means of a pharmacological agent, without inducing ischemia per se. Specifically, the use of halogenated inhalational anaesthetics to induce preconditioning has garnered attention recently for its role in manipulating the cellular mechanics instrumental in enhancing the heart's resistance to ischaemic insults. This review details the specific cellular mechanisms involved in ischaemic preconditioning together with a discussion of the pharmacological manipulation of these pathways.


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