Guerrero Orriach Jose Luis Pages 5448 - 5448 ( 1 )
The possibility of achieving organ protection by the perioperative administration of different drugs opens up a new field of research in preoperative medicine, anesthesia, and critical care surgery. In this study we review the current situation in perioperative management of various diseases and assess the benefits of different drugs for organ preservation, in order to evaluate the current evidence on the organ protection offered by different pharmacological groups [1]. The intraoperative administration of halogenated anesthetic drugs is a controversial issue. Previous studies have not conclusively demonstrated the clinical benefit of these agents on the target organ. Here we assess their effect in a variety of situations, including systemic inflammatory response syndrome, which is particularly frequent in the postoperative period [1,2]. Ketamine has been constantly reviewed because through its activity on NMDA-receptors, might be related to a neuroprotective effect on the brain areas. where neurological damage usually happens. We explore the experience with this drug in order to determine the current state of the art and to assess the indication of different hypnotic drugs in these situations [3]. In certain specialties such as cardiac surgery, preoperative optimization of patients is becoming increasingly important. For this purpose, a variety of drugs are administered. The preoperative use of calcium channel sensitizers to provide cardiac protection is a particularly novel development. Several studies are currently underway to assess its value, and their results may lead to changes in clinical practice in our patients [4].Since kidney acute failure represents a cause of high morbidity and mortality during cardiac surgery, the possibility of their protection in this context has been also an objective of this review through a detailed study of the current evidence of perioperative therapeutic measures applied in this situation [1,5]. The cardiac protective properties of halogenated agents (desflurane, isoflurane and sevoflurane) when they are compared with intravenous hypnotic drugs; have not been confirmed in non-cardiac surgery and mixed results exist for patients admitted in postoperative intensive care units; Dr. Landoni, explains the evidence in this issue [6]. Finally, we review the intraoperative use of opioids and the evidence of their superiority over other techniques for reducing nociception, and our results shed new light on the current situation. The electrophysiologic effects of opioids should be taken in consideration for the choice of anesthetic agents [7].
Department of anaesthesia. Hospital Virgen de la Victoria. Málaga. Spain.