Cellular targets of inhalational anaesthetic- and opioid receptor agonist-induced cardioprotection

Abstract

Several anaesthetics and anaesthetic adjuvants have been shown to limit the extent of myocardial injury due to ischaemia and reperfusion, a protective phenomenon known as anaesthetic-induced cardioprotection. Inhalational anaesthetics and opioid receptor agonists are among the key players in anaesthetic-induced cardioprotection. However, the mechanisms underlying anaesthetic-induced cardioprotection are not fully understood, and as such there are currently no concrete guidelines regarding the choice of anaesthetic protocols designed to enhance cardioprotection. This mini-review provides insights into the mechanisms through which the cardioprotection due to inhalational agents and opioid receptor agonists occurs, and discusses the clinical implications thereof. The mechanisms underlying this cardioprotection are diverse and remain unresolved, but several cellular signaling cascades involve key targets such as receptors, sarcolemmal- and mitochondrial ATP-sensitive K+ channels, the mitochondrial permeability transition pore, glycogen synthase kinase-3 beta, nitric oxide, and anti-apoptotic factors. Such factors represent potential therapeutic targets in promoting anaesthetic-induced cardioprotection.

Keywords:anaesthetic,cardiac, cardioprotection, inhalational agents, opioid receptor