The effect of volatile anesthetics on myocardial ischemia/reperfusion: a review and meta-analysis

Introduction: ischemia-reperfusion injury is one of the most important cellular mechanisms involved in myocardial injury; there is a possible protective role for volatile agents on myocardial cells against ischemia-reperfusion injury through inhibition of Ca2+ overload; in this review, the effects of volatile agents on myocardial ischemia-reperfusion were assessed using a meta- analysis methodology.Materials and methods: from 2007 to 2012, using the following keywords, ischemia reperfusion, volatile agent, volatile anesthetic, preconditioning, myocardial, protection, Sevoflurane, Isoflurane, Desflurane. To select more related studies, the search was made narrower using "ischemia reperfusion" and "volatile agent" to yield in 38 articles which could be entered into study calculations, directly or indirectly, with one of the following indicators: odds ratio, standardized mean reference, relative risk and effect size.Results: after final screening, 20 articles remaining as related to "the effects of volatile agents on myocardial ischemia/reperfusion". The study demonstrated significant decrease in myocardial ischemic region related to "exposure to volatile agents" (p < 0.01); also, there was not a statistically significant difference between the coverage areas of confidence intervals of 3 different drug doses: 1 MAC; 1.5 MAC and 2 MAC (p value>0.05); at the same time, there was no statistically significant difference regarding the protective effects of volatile anesthetic gases on ischemic outcome (p value>0.05).Discussion: this study demonstrated that all volatile anesthetics could lead to attenuation of myocardial infarct size; though there is no difference between different doses of volatile agents regarding their protective effects and the protective effects of volatile anesthetics are not different regarding their the main genes involved in cardioprotectionKey words: volatile, ischemia reperfusion, ischemia reperfusion