DOI: The Greek E-Journal of Perioperative Medicine 2010; 8:84-98



A lot of techniques have been tested for their potential to salvage myocardial tissue during an episode of acute ischaemia. Techniques that are applied before the onset of acute ischaemia, i.e. preconditioning techniques, have proved to be really protective, but scheduled ischaemia or at least high probability for the timing of it’s occurrence, is a pre-requisite for their application. This disadvantage led to experimentation on techniques that can be applied immediately after the onset of acute ischaemia or at least on the time of reperfusion. The main target of the concept of the “first golden hour after an acute cardiac ischaemic episode” is early reperfusion. Unfortunately, reperfusion injury outweighs the deleterious ef-fects of the primary ischaemic episode. Postconditioning, at its mechanical version, was invented experimentally and proved really protective. Soon, pharma-ceutical substances that had already proved their efficacy in preconditioning turned out almost equally effective in postconditioning. Volatile anaesthetics, opioids and beta blockers, so delicately managed in anesthesia practice, offer important protective advantages in animal experimental investigations and very encouraging results in limited clinical trials in humans. Detailed methods of their clinical application and the delineation of possible interactions with other substances will presumably offer new terrain of clinical application of these anaesthetics that from the time of their discovery continue to surprise us with their exceptional properties.

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