Halogenated anesthetic agents (desflurane, isoflurane and sevoflurane) may have cardioprotective
properties at therapeutic doses against myocardial intraoperative ischemia-reperfusion injury.
Cardioprotection mechanisms are related to mitochondrial and anti-apoptotic signaling pathways. Experimentals
and human studies have proven that their use may reduce morbidity and mortality in the
setting of cardiac surgery, including a reduction in myocardial infarct size and mechanical ventilation
needs. In contrast, total intra-venous propofol based anesthesia may be detrimental. In the present review,
we show the rationale for the perioperative use of halogenated anesthetics based on mechanisms
of action, experimental research and human studies. Considerations and major concerns regarding their
use, the present evidence for their use in other areas, such as major non-cardiac surgery and intensive
care unit patients, and future perspectives are also discussed.
Keywords: Halogenated agents, total intra-venous anesthesia, cardiac surgery, outcomes, intensive care unit, anesthesia, intensive
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