Anesthetic Management of Cardiac Ischemic Reperfusion Injury during Cardiac Surgery
Amr Mohamed Mohamed Hashem;
Abstract
T
he heart and its associated structures form an intricate system that has the primary aim of pumping blood through the lungs and around the body. For this reason, a good knowledge of the normal anatomy of the cardiovascular system is essential to understand pathology, and to manage patients with cardiovascular disease
The term, ischemia, to denote deficient blood supply to tissues due to obstruction of the arterial inflow was first used in the early nineteenth century. Ischemia-reperfusion (IR) injury is known as the tissue damage that results from the process of ischemia followed by the further insult induced by the restoration of blood supply to ischemic tissues. Reperfusion causes an inflammatory response as a result of the induction of various cytokines and chemokines and increased oxidative stress, which lead to microvascular dysfunction in the ischemic tissues and organs. The seminal observation that reperfusion following ischemia was associated with myocardial injury was made in 1960 by Jennings. Their report was based on experiments with canine hearts subjected to coronary ligation in which reperfusion appeared to accelerate the development of necrosis. Whether reperfusion is independently responsible for tissue injury, or simply hastens the demise of cells otherwise destined for necrosis, remained a matter of debate for some years. After the discovery of ischemic preconditioning, the independent effects of ischemia and reperfusion began to be unraveled from one another.
he heart and its associated structures form an intricate system that has the primary aim of pumping blood through the lungs and around the body. For this reason, a good knowledge of the normal anatomy of the cardiovascular system is essential to understand pathology, and to manage patients with cardiovascular disease
The term, ischemia, to denote deficient blood supply to tissues due to obstruction of the arterial inflow was first used in the early nineteenth century. Ischemia-reperfusion (IR) injury is known as the tissue damage that results from the process of ischemia followed by the further insult induced by the restoration of blood supply to ischemic tissues. Reperfusion causes an inflammatory response as a result of the induction of various cytokines and chemokines and increased oxidative stress, which lead to microvascular dysfunction in the ischemic tissues and organs. The seminal observation that reperfusion following ischemia was associated with myocardial injury was made in 1960 by Jennings. Their report was based on experiments with canine hearts subjected to coronary ligation in which reperfusion appeared to accelerate the development of necrosis. Whether reperfusion is independently responsible for tissue injury, or simply hastens the demise of cells otherwise destined for necrosis, remained a matter of debate for some years. After the discovery of ischemic preconditioning, the independent effects of ischemia and reperfusion began to be unraveled from one another.
Other data
| Title | Anesthetic Management of Cardiac Ischemic Reperfusion Injury during Cardiac Surgery | Other Titles | المعالجة التخديرية لإصابة أنسجة القلب الناتجة عن إعادة ضخ الدم بعد فقر الدم الموضعى أثناء جراحات القلب | Authors | Amr Mohamed Mohamed Hashem | Issue Date | 2017 |
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