{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T10:01:58Z","timestamp":1772445718185,"version":"3.50.1"},"reference-count":114,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Background: Interest in inhalational anesthesia in cardiac surgery has resurged as volatile anesthetics exert biological effects extending beyond hypnosis. Sevoflurane and desflurane activate mitochondrial cytoprotective signaling pathways, modulate inflammatory and endothelial responses and may attenuate ischemia\u2013reperfusion injury during cardiopulmonary bypass, potentially influencing postoperative organ function and recovery. Methods: This narrative review critically examines experimental and clinical evidence on the use of volatile anesthetics in cardiac anesthesia. The current literature was analyzed to elucidate mechanistic foundations of myocardial and extracardiac organ protection, hemodynamic and metabolic effects, and the influence of patient-specific vulnerability profiles on perioperative outcomes. Results: Preclinical studies consistently demonstrate that volatile anesthetics trigger mitochondrial protective pathways, including K-ATP channel activation, controlled reactive oxygen species signaling and inhibition of the mitochondrial permeability transition pore. Clinical studies suggest potential benefits in myocardial protection and modulation of systemic inflammatory and microcirculatory responses. However, translation into consistent clinical outcome improvement remains heterogeneous, influenced by variability in surgical procedures, anesthetic protocols and patient risk stratification. Conclusions: Volatile anesthetics exhibit mechanistic properties supporting a potential role in organ protection during cardiac surgery. Nevertheless, clinical evidence remains inconclusive, underscoring the need for refined patient stratification and precision-based perioperative strategies. Identifying knowledge gaps and research priorities may facilitate rational, individualized integration of inhalational anesthesia into contemporary cardiac surgical practice.<\/jats:p>","DOI":"10.3390\/jpm16030138","type":"journal-article","created":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T08:51:57Z","timestamp":1772441517000},"page":"138","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Volatile Anesthesia in Contemporary Cardiac Surgery: Clinical Implications, Organ Protection and Perspectives for Personalized Perioperative Care"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-5046-4275","authenticated-orcid":false,"given":"Debora Emanuela","family":"Torre","sequence":"first","affiliation":[{"name":"Department of Cardiac Anesthesia and Intensive Care Unit, Cardiac Surgery, Ospedale dell\u2019Angelo, Mestre, 30174 Venice, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0119-6549","authenticated-orcid":false,"given":"Carmelo","family":"Pirri","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35122 Padua, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/j.bpa.2015.03.002","article-title":"Myocardial injury and protection related to cardiopulmonary bypass","volume":"29","author":"Moerman","year":"2015","journal-title":"Best Pract. Res. Clin. Anaesthesiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1007\/s00395-024-01062-0","article-title":"Cardioprotection in cardiovascular surgery","volume":"119","author":"Sabe","year":"2024","journal-title":"Basic Res. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1097\/00000542-200407000-00005","article-title":"Choice of primary anesthetic regimen can influence intensive care unit length of stay after coronary surgery with cardiopulmonary bypass","volume":"101","author":"Cromheecke","year":"2004","journal-title":"Anesthesiology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1097\/00000542-200408000-00009","article-title":"Cardioprotective properties of sevoflurane in patients undergoing coronary surgery with cardiopulmonary bypass are related to the modalities of its administration","volume":"101","author":"Cromheecke","year":"2004","journal-title":"Anesthesiology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"133","DOI":"10.4103\/aca.aca_147_22","article-title":"Narrative review of systemic inflammatory response mechanisms in cardiac surgery and immunomodulatory role of anesthetic agents","volume":"26","author":"Maisat","year":"2023","journal-title":"Ann. Card. Anaesth."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1038\/s41569-020-0403-y","article-title":"Myocardial ischaemia-reperfusion injury and cardioprotection in perspective","volume":"17","author":"Heusch","year":"2020","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1177\/0267659113503975","article-title":"Volatile anesthetic-induced preconditioning","volume":"29","author":"Swyers","year":"2014","journal-title":"Perfusion"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/s40001-018-0308-y","article-title":"Comparison of volatile anesthetic-induced preconditioning in cardiac and cerebral system: Molecular mechanisms and clinical aspects","volume":"23","author":"Chen","year":"2018","journal-title":"Eur. J. Med. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"138","DOI":"10.5152\/eurasianjmed.2023.23376","article-title":"Myocardial Protection in Cardiac Surgery: Exploring the Influence of Anesthetic Agents","volume":"55","author":"Dost","year":"2023","journal-title":"Eurasian J. Med."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Li, F., and Yuan, Y. (2015). Meta-analysis of the cardioprotective effect of sevoflurane versus propofol during cardiac surgery. BMC Anesthesiol., 15.","DOI":"10.1186\/s12871-015-0107-8"},{"key":"ref_11","first-page":"1058","article-title":"Meta-analysis of protective effect of sevoflurane on myocardium during cardiac surgery","volume":"18","author":"Xu","year":"2014","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1093\/bja\/aei142","article-title":"Effect of three different anaesthetic agents on the postoperative production of cardiac troponin T in paediatric cardiac surgery","volume":"94","author":"Malagon","year":"2005","journal-title":"Br. J. Anaesth."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1315","DOI":"10.1097\/00000542-200306000-00004","article-title":"Preconditioning by sevoflurane decreases biochemical markers for myocardial and renal dysfunction in coronary artery bypass graft surgery: A double-blinded, placebo-controlled, multicenter study","volume":"98","author":"Julier","year":"2003","journal-title":"Anesthesiology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"4","DOI":"10.4103\/0971-9784.45006","article-title":"Halogenated anaesthetics and cardiac protection in cardiac and non-cardiac anaesthesia","volume":"12","author":"Landoni","year":"2009","journal-title":"Ann. Card. Anaesth."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1053\/j.jvca.2006.02.035","article-title":"Effects of sevoflurane on biomechanical markers of hepatic and renal dysfunction after coronary artery surgery","volume":"20","author":"Lorsomradee","year":"2006","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1053\/j.jvca.2009.01.022","article-title":"Volatile anesthetics reduce mortality in cardiac surgery","volume":"23","author":"Bignami","year":"2009","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"319","DOI":"10.4103\/aca.ACA_130_20","article-title":"Volatile anesthetic preconditioning modulates oxidative stress and nitric oxide in patients undergoing coronary artery bypass grafting","volume":"24","author":"Dharmalingam","year":"2021","journal-title":"Ann. Card. Anaesth."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/j.jclinane.2017.05.010","article-title":"Inhalation versus intravenous anaesthesia for adults undergoing on-pump or off-pump coronary artery bypass grafting: A systematic review and meta-analysis of randomized controlled trials","volume":"40","author":"Agarwal","year":"2017","journal-title":"J. Clin. Anesth."},{"key":"ref_19","first-page":"37","article-title":"Role of Anaesthetic Choice in Improving Outcome after Cardiac Surgery","volume":"27","author":"Stefan","year":"2020","journal-title":"Rom. J. Anaesth. Intensive Care"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Zhang, C., He, C., Chen, Z., Chen, X., Qin, J., Xu, Y., and Ma, J. (2023). The effects of volatile anesthetics and propofol in patients undergoing off-pump coronary artery bypass grafting: A systematic review and meta-analysis. Front. Cardiovasc. Med., 10.","DOI":"10.3389\/fcvm.2023.1271557"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"886","DOI":"10.1093\/bja\/aet231","article-title":"Anaesthetic drugs and survival: A Bayesian network meta-analysis of randomized trials in cardiac surgery","volume":"111","author":"Landoni","year":"2013","journal-title":"Br. J. Anaesth."},{"key":"ref_22","first-page":"844603","article-title":"Impact of anesthetic technique on troponin I levels in pediatric cardiac surgery: A randomized clinical trial","volume":"75","author":"Barelli","year":"2025","journal-title":"Braz. J. Anesthesiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1097\/EJA.0b013e3283560aea","article-title":"Cardioprotective effect of sevoflurane and propofol during anaesthesia and the postoperative period in coronary bypass graft surgery: A double-blind randomised study","volume":"29","author":"Soro","year":"2012","journal-title":"Eur. J. Anaesthesiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1932","DOI":"10.1053\/j.jvca.2024.05.027","article-title":"Comparison of Propofol-Based Total Intravenous Anesthesia versus Volatile Anesthesia with Sevoflurane for Postoperative Delirium in Adult Coronary Artery Bypass Grafting Surgery: A Prospective Randomized Single-Blinded Study","volume":"38","author":"Varsha","year":"2024","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"3306","DOI":"10.1053\/j.jvca.2025.08.038","article-title":"TIVA vs Volatile Anesthesia in CABG Surgery: Effects on Inflammatory and Cognitive Outcomes","volume":"39","author":"Garg","year":"2025","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"665","DOI":"10.23736\/S0375-9393.19.13377-9","article-title":"Inhalation versus intravenous anesthesia for adults undergoing heart valve surgery: A systematic review and meta-analysis","volume":"85","author":"Ren","year":"2019","journal-title":"Minerva Anestesiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1053\/j.jvca.2025.09.238","article-title":"Total Intravenous Versus Volatile Anesthesia in Pediatric Cardiac Surgery: Inflammatory Response and Early Recovery Profiles","volume":"40","author":"Patel","year":"2026","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1016\/j.bja.2024.05.008","article-title":"Effect of volatile versus propofol anaesthesia on major complications and mortality after cardiac surgery: A multicentre randomised trial","volume":"133","author":"Deng","year":"2024","journal-title":"Br. J. Anaesth."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1213\/ANE.0000000000006257","article-title":"Volatile Versus Total Intravenous Anesthesia on Postoperative Delirium in Adult Patients Undergoing Cardiac Valve Surgery: A Randomized Clinical Trial","volume":"136","author":"Jiang","year":"2023","journal-title":"Anesth. Analg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1007\/s40140-021-00466-1","article-title":"Volatile Versus Intravenous Anesthetics in Cardiac Anesthesia: A Narrative Review","volume":"11","author":"Uhlig","year":"2021","journal-title":"Curr. Anesthesiol. Rep."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1214","DOI":"10.1056\/NEJMoa1816476","article-title":"Volatile Anesthetics versus Total Intravenous Anesthesia for Cardiac Surgery","volume":"380","author":"Landoni","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"ezad424","DOI":"10.1093\/ejcts\/ezad424","article-title":"Myocardial protection in cardiac surgery-hindsight from the 2020s","volume":"64","author":"Mukharyamov","year":"2023","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1177\/02676591211031095","article-title":"Del Nido cardioplegia for myocardial protection in adult cardiac surgery: A systematic review and update meta-analysis","volume":"38","author":"Zhai","year":"2023","journal-title":"Perfusion"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1016\/S0008-6363(03)00533-9","article-title":"Mitochondrial permeability transition pore opening during myocardial reperfusion\u2014A target for cardioprotection","volume":"61","author":"Halestrap","year":"2004","journal-title":"Cardiovasc. Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.1016\/j.bbabio.2007.05.008","article-title":"The role of mitochondria in protection of the heart by preconditioning","volume":"1767","author":"Halestrap","year":"2007","journal-title":"Biochim. Biophys. Acta"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1016\/j.redox.2015.08.020","article-title":"Reperfusion injury and reactive oxygen species: The evolution of a concept","volume":"6","author":"Granger","year":"2015","journal-title":"Redox Biol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1038\/s41569-021-00506-7","article-title":"Myocardial stunning and hibernation revisited","volume":"18","author":"Heusch","year":"2021","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1111\/aor.14171","article-title":"Narrative review of the systemic inflammatory reaction to cardiac surgery and cardiopulmonary bypass","volume":"46","author":"Squiccimarro","year":"2022","journal-title":"Artif. Organs"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Raja, S.G., Benedetto, U., and Marczin, N. (2024). Editorial: Inflammation and heart surgery. Front. Cardiovasc. Med., 11.","DOI":"10.3389\/fcvm.2024.1493898"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Banerjee, D., Feng, J., and Sellke, F.W. (2024). Strategies to attenuate maladaptive inflammatory response associated with cardiopulmonary bypass. Front. Surg., 11.","DOI":"10.3389\/fsurg.2024.1224068"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1177\/0267659120942656","article-title":"Myocardial protection in cardiac surgery: How limited are the options? A comprehensive literature review","volume":"36","author":"Whittaker","year":"2021","journal-title":"Perfusion"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"48410","DOI":"10.31083\/HSF48410","article-title":"Perioperative Myocardial Protection in Adult Cardiac Surgery: Critical Gaps in Current Strategies and Perspectives for Clinical Practice","volume":"28","author":"LaGrange","year":"2025","journal-title":"Heart Surg. Forum"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"909","DOI":"10.34067\/KID.0000000000000466","article-title":"Cardiac Surgery-Associated Acute Kidney Injury","volume":"5","author":"Scurt","year":"2024","journal-title":"Kidney360"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Torre, D.E., Carbognin, S., Mangino, D., and Pirri, C. (2025). Renal Resistive Index in Cardiac Surgery: A Narrative Review. Anesth. Res., 2.","DOI":"10.3390\/anesthres2030019"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Pedriali, G., Ramaccini, D., Bouhamida, E., Wieckowski, M.R., Giorgi, C., Tremoli, E., and Pinton, P. (2022). Perspectives on mitochondrial relevance in cardiac ischemia\/reperfusion injury. Front. Cell Dev. Biol., 10.","DOI":"10.3389\/fcell.2022.1082095"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1097\/00000542-200207000-00030","article-title":"The systemic inflammatory response to cardiac surgery: Implications for the anesthesiologist","volume":"97","author":"Laffey","year":"2002","journal-title":"Anesthesiology"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1584","DOI":"10.1213\/01.ANE.0000153483.61170.0C","article-title":"Cardioprotection with volatile anesthetics: Mechanisms and clinical implications","volume":"100","author":"Turani","year":"2005","journal-title":"Anesth. Analg."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1007\/BF03017409","article-title":"Myocardial protection by anesthetic agents against ischemia-reperfusion injury: An update for anesthesiologists","volume":"49","author":"Kato","year":"2002","journal-title":"Can. J. Anesth."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"2051","DOI":"10.1111\/bph.12981","article-title":"Anaesthetics as cardioprotectants: Translatability and mechanism","volume":"172","author":"Kikuchi","year":"2015","journal-title":"Br. J. Pharmacol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1111\/anae.12975","article-title":"Peri-operative anaesthetic myocardial preconditioning and protection\u2014Cellular mechanisms and clinical relevance in cardiac anaesthesia","volume":"70","author":"Kunst","year":"2015","journal-title":"Anaesthesia"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1097\/00000542-200207000-00003","article-title":"Volatile anesthetics mimic cardiac preconditioning by priming the activation of mitochondrial K(ATP) channels via multiple signaling pathways","volume":"97","author":"Zaugg","year":"2002","journal-title":"Anesthesiology"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1913","DOI":"10.1111\/bph.12903","article-title":"Signalling pathways and mechanisms of protection in pre- and postconditioning: Historical perspective and lessons for the future","volume":"172","author":"Cohen","year":"2015","journal-title":"Br. J. Pharmacol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.1152\/physrev.00009.2003","article-title":"Preconditioning the myocardium: From cellular physiology to clinical cardiology","volume":"83","author":"Yellon","year":"2003","journal-title":"Physiol. Rev."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1159\/000103747","article-title":"Mitochondrial permeability transition pore opening as an endpoint to initiate cell death and as a putative target for cardioprotection","volume":"20","author":"Javadov","year":"2007","journal-title":"Cell. Physiol. Biochem."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1097\/00000542-199708000-00024","article-title":"Isoflurane mimics ischemic preconditioning via activation of K(ATP) channels: Reduction of myocardial infarct size with an acute memory phase","volume":"87","author":"Kersten","year":"1997","journal-title":"Anesthesiology"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1007\/s44254-024-00084-0","article-title":"Protective effects of sevoflurane conditioning against myocardial ischemia-reperfusion injury: A review of evidence from animal and clinical studies","volume":"3","author":"Lin","year":"2025","journal-title":"Anesthesiol. Perioper. Sci."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/s13063-020-04809-x","article-title":"Effect of sevoflurane on the inflammatory response during cardiopulmonary bypass in cardiac surgery: The study protocol for a randomized controlled trial","volume":"22","author":"Cardoso","year":"2021","journal-title":"Trials"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1372","DOI":"10.1097\/00000542-199905000-00022","article-title":"Inhibition of neutrophil activation by volatile anesthetics decreases adhesion to cultured human endothelial cells","volume":"90","author":"Zahler","year":"1999","journal-title":"Anesthesiology"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1447","DOI":"10.1097\/00000542-199612000-00027","article-title":"Sevoflurane inhibits human platelet aggregation and thromboxane A2 formation, possibly by suppression of cyclooxygenase activity","volume":"85","author":"Hirakata","year":"1996","journal-title":"Anesthesiology"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1749","DOI":"10.1213\/ane.0b013e318172f9e9","article-title":"Delayed inhibition of agonist-induced granulocyte-platelet aggregation after low-dose sevoflurane inhalation in humans","volume":"106","author":"Wacker","year":"2008","journal-title":"Anesth. Analg."},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Astapenko, D., Benes, J., Pouska, J., Lehmann, C., Islam, S., and Cerny, V. (2019). Endothelial glycocalyx in acute care surgery\u2014What anaesthesiologists need to know for clinical practice. BMC Anesthesiol., 19.","DOI":"10.1186\/s12871-019-0896-2"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"162","DOI":"10.3109\/08941939.2011.618524","article-title":"Ischemia-reperfusion-induced unmeasured anion generation and glycocalyx shedding: Sevoflurane versus propofol anesthesia","volume":"25","author":"Annecke","year":"2012","journal-title":"J. Investig. Surg."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1631\/jzus.B1000155","article-title":"Sevoflurane postconditioning reduces myocardial reperfusion injury in rat isolated hearts via activation of PI3K\/Akt signaling and modulation of Bcl-2 family proteins","volume":"11","author":"Yu","year":"2010","journal-title":"J. Zhejiang Univ. Sci. B"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1093\/bja\/aei026","article-title":"Preconditioning with sevoflurane decreases PECAM-1 expression and improves one-year cardiovascular outcome in coronary artery bypass graft surgery","volume":"94","author":"Garcia","year":"2005","journal-title":"Br. J. Anaesth."},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Iaizzo, P.A. (2005). The Effects of Anesthetic Agents on Cardiac Function. Handbook of Cardiac Anatomy, Physiology, and Devices, Humana Press.","DOI":"10.1007\/978-1-59259-835-9"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1177\/108925320601000107","article-title":"Volatile anesthetics and cardiac function","volume":"10","year":"2006","journal-title":"Semin. Cardiothorac. Vasc. Anesth."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1111\/j.0001-5172.2004.00391.x","article-title":"Effects of volatile anesthetics on cardiac ion channels","volume":"48","author":"Fassl","year":"2004","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1097\/00000542-199410000-00015","article-title":"Effects of isoflurane on regional coronary blood flow and myocardial tissue pressure in chronically instrumented dogs","volume":"81","author":"Kim","year":"1994","journal-title":"Anesthesiology"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.janh.2017.04.002","article-title":"Isoflurane and the Coronary Steal Controversy of the 1980s: Origin, Resolution, and Legacy","volume":"3","author":"Crystal","year":"2017","journal-title":"J. Anesth. Hist."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1177\/0267659115571174","article-title":"Effects of sevoflurane vs. propofol on mitochondrial functional activity after ischemia-reperfusion injury and the influence on clinical parameters in patients undergoing CABG surgery with cardiopulmonary bypass","volume":"30","author":"Sirvinskas","year":"2015","journal-title":"Perfusion"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"110417","DOI":"10.1016\/j.biopha.2020.110417","article-title":"Sevoflurane as opposed to propofol anesthesia preserves mitochondrial function and alleviates myocardial ischemia\/reperfusion injury","volume":"129","author":"Lotz","year":"2020","journal-title":"Biomed. Pharmacother."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1186\/1475-2840-12-42","article-title":"Diabetes, perioperative ischaemia and volatile anaesthetics: Consequences of derangements in myocardial substrate metabolism","volume":"12","author":"Bulte","year":"2013","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"159","DOI":"10.34172\/jcvtr.025.33239","article-title":"Effect of sevoflurane on hemodynamic response during cardiopulmonary bypass in cardiac surgery patients: A randomized controlled trial","volume":"17","author":"Lam","year":"2025","journal-title":"J. Cardiovasc. Thorac. Res."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"e23253","DOI":"10.1097\/MD.0000000000023253","article-title":"Anaesthesia and ICU sedation with sevoflurane do not reduce myocardial injury in patients undergoing cardiac surgery: A randomized prospective study","volume":"99","author":"Guinot","year":"2020","journal-title":"Medicine"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1097\/00000542-199808000-00020","article-title":"Effects of volatile anesthetics on atrial and AV nodal electrophysiological properties in guinea pig isolated perfused heart","volume":"89","author":"Raatikainen","year":"1998","journal-title":"Anesthesiology"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1177\/0267659108094528","article-title":"Direct effects of volatile anesthetics on cardiac function","volume":"23","author":"Redford","year":"2008","journal-title":"Perfusion"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1053\/j.jvca.2006.05.012","article-title":"Myocardial damage prevented by volatile anesthetics: A multicenter randomized controlled study","volume":"20","author":"Guarracino","year":"2006","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1053\/j.jvca.2007.02.013","article-title":"Desflurane and sevoflurane in cardiac surgery: A meta-analysis of randomized clinical trials","volume":"21","author":"Landoni","year":"2007","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.1053\/j.jvca.2017.12.029","article-title":"The Discovery of Myocardial Preconditioning Using Volatile Anesthetics: A History and Contemporary Clinical Perspective","volume":"32","author":"Pagel","year":"2018","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"837","DOI":"10.2147\/DDDT.S127916","article-title":"Cardioprotection with halogenated gases: How does it occur?","volume":"11","year":"2017","journal-title":"Drug Des. Dev. Ther."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"1429","DOI":"10.1097\/ALN.0000000000003236","article-title":"Volatile Anesthetics versus Propofol for Cardiac Surgery with Cardiopulmonary Bypass: Meta-analysis of Randomized Trials","volume":"132","author":"Bonanni","year":"2020","journal-title":"Anesthesiology"},{"key":"ref_82","doi-asserted-by":"crossref","unstructured":"Jiao, X.F., Lin, X.M., Ni, X.F., Li, H.L., Zhang, C., Yang, C.S., Song, H.X., Yi, Q.S., and Zhang, L.L. (2019). Volatile anesthetics versus total intravenous anesthesia in patients undergoing coronary artery bypass grafting: An updated meta-analysis and trial sequential analysis of randomized controlled trials. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0224562"},{"key":"ref_83","doi-asserted-by":"crossref","unstructured":"\u0218tefan, M., Predoi, C., Goicea, R., and Filipescu, D. (2022). Volatile Anaesthesia versus Total Intravenous Anaesthesia for Cardiac Surgery-A Narrative Review. J. Clin. Med., 11.","DOI":"10.3390\/jcm11206031"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1093\/bja\/aer091","article-title":"Cognitive function after sevoflurane- vs propofol-based anaesthesia for on-pump cardiac surgery: A randomized controlled trial","volume":"106","author":"Schoen","year":"2011","journal-title":"Br. J. Anaesth."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1053\/j.jvca.2023.09.038","article-title":"Comparison of Volatile Anesthetics Versus Propofol on Postoperative Cognitive Function After Cardiac Surgery: A Systematic Review and Meta-analysis","volume":"38","author":"Han","year":"2024","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"3127","DOI":"10.1016\/j.jtcvs.2014.07.085","article-title":"Volatile anesthetics in preventing acute kidney injury after cardiac surgery: A systematic review and meta-analysis","volume":"148","author":"Cai","year":"2014","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"1548","DOI":"10.1007\/s00134-012-2610-4","article-title":"Effects of anesthetic regimes on inflammatory responses in a rat model of acute lung injury","volume":"38","author":"Fortis","year":"2012","journal-title":"Intensive Care Med."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1213\/ANE.0b013e31824762f0","article-title":"The volatile anesthetic isoflurane prevents ventilator-induced lung injury via phosphoinositide 3-kinase\/Akt signaling in mice","volume":"114","author":"Faller","year":"2012","journal-title":"Anesth. Analg."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"189863","DOI":"10.1155\/2015\/189863","article-title":"Cardiopulmonary bypass and oxidative stress","volume":"2015","author":"Zakkar","year":"2015","journal-title":"Oxid. Med. Cell. Longev."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"e3424","DOI":"10.1097\/MD.0000000000003424","article-title":"Low-Dose Sevoflurane May Reduce Blood Loss and Need for Blood Products After Cardiac Surgery: A Prospective, Randomized Pilot Study","volume":"95","author":"Tan","year":"2016","journal-title":"Medicine"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1053\/j.jvca.2013.05.030","article-title":"Use of volatile anesthetics during cardiopulmonary bypass: A systematic review of adverse events","volume":"28","author":"Landoni","year":"2014","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1053\/j.jvca.2012.12.012","article-title":"Randomized trial on the effect of sevoflurane on polypropylene membrane oxygenator performance","volume":"27","author":"Arnoni","year":"2013","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1093\/bja\/aet018","article-title":"Changes in sevoflurane plasma concentration with delivery through the oxygenator during on-pump cardiac surgery","volume":"110","author":"Nitzschke","year":"2013","journal-title":"Br. J. Anaesth."},{"key":"ref_94","first-page":"e1150","article-title":"Volatile anesthetics in oxygenators during cardiopulmonary bypass","volume":"53","author":"Quintero","year":"2025","journal-title":"Colomb. J. Anestesiol."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"1218","DOI":"10.1053\/j.jvca.2016.08.009","article-title":"A Novel Anti-Pollution Filter for Volatile Agents During Cardiopulmonary Bypass: Preliminary Tests","volume":"31","author":"Landoni","year":"2017","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"240","DOI":"10.4103\/0971-9784.179592","article-title":"Tricks, tips, and literature review on the adapted vaporize system to deliver volatile agents during cardiopulmonary bypass","volume":"19","author":"Cassara","year":"2016","journal-title":"Ann. Card. Anaesth."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"2181","DOI":"10.1053\/j.jvca.2020.03.013","article-title":"Volatile Anesthesia Versus Total Intravenous Anesthesia During Cardiopulmonary Bypass: A Narrative Review on the Technical Challenges and Considerations","volume":"34","author":"Yeoh","year":"2020","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1213\/ANE.0000000000006147","article-title":"Anesthetic Preferences for Cardiac Anesthesia: A Survey of the Society of Cardiovascular Anesthesiologists","volume":"136","author":"Beydoun","year":"2023","journal-title":"Anesth. Analg."},{"key":"ref_99","doi-asserted-by":"crossref","unstructured":"Gaya da Costa, M., Kalmar, A.F., and Struys, M.M.R.F. (2021). Inhaled Anesthetics: Environmental Role, Occupational Risk, and Clinical Use. J. Clin. Med., 10.","DOI":"10.3390\/jcm10061306"},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"391","DOI":"10.4103\/aca.ACA_126_17","article-title":"Atmospheric pollution in cardiac operating rooms","volume":"20","author":"Kapoor","year":"2017","journal-title":"Ann. Card. Anaesth."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"4","DOI":"10.22514\/sv.2025.123","article-title":"Carbon footprint and sustainable development in anesthesia: A narrative review","volume":"21","author":"Chen","year":"2025","journal-title":"Signa Vitae"},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1111\/anae.15598","article-title":"Principles of environmentally-sustainable anaesthesia: A global consensus statement from the World Federation of Societies of Anaesthesiologists","volume":"77","author":"White","year":"2022","journal-title":"Anaesthesia"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"e227","DOI":"10.1016\/S2542-5196(25)00027-0","article-title":"Greenhouse gas impact from medical emissions of halogenated anaesthetic agents: A sales-based estimate","volume":"9","author":"Talbot","year":"2025","journal-title":"Lancet Planet. Health"},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"100362","DOI":"10.1016\/j.bjao.2024.100362","article-title":"Environmental impact of commonly used anaesthetic agents: Systematic literature review with narrative synthesis","volume":"13","author":"Lloyd","year":"2024","journal-title":"BJA Open"},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1111\/anae.16221","article-title":"Reducing the carbon footprint of general anaesthesia: A comparison of total intravenous anaesthesia vs. a mixed anaesthetic strategy in 47,157 adult patients","volume":"79","author":"Bernat","year":"2024","journal-title":"Anaesthesia"},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1213\/ANE.0b013e3181e058d7","article-title":"Global warming potential of inhaled anesthetics: Application to clinical use","volume":"111","author":"Ryan","year":"2010","journal-title":"Anesth. Analg."},{"key":"ref_107","doi-asserted-by":"crossref","unstructured":"Iqbal, S., Karia, A., Kamming, D., Herron, D., O\u2019Shea, L., and Vindrola-Padros, C. (2024). Anaesthesia and climate change: Time to wake up? A rapid qualitative appraisal exploring the views of anaesthetic practitioners regarding the transition to TIVA and the reduction of desflurane. BMC Anesthesiol., 24.","DOI":"10.1186\/s12871-024-02693-5"},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"e195","DOI":"10.1016\/j.bja.2021.03.004","article-title":"Climate impacts of anaesthesia","volume":"126","author":"Slingo","year":"2021","journal-title":"Br. J. Anaesth."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1111\/anae.16189","article-title":"The science of climate change and the effect of anaesthetic gas emissions","volume":"79","author":"Slingo","year":"2024","journal-title":"Anaesthesia"},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"1751","DOI":"10.1213\/ANE.0000000000005234","article-title":"Perioperative Cardioprotection: Clinical Implications","volume":"131","author":"Roth","year":"2020","journal-title":"Anesth. Analg."},{"key":"ref_111","first-page":"ivaf002","article-title":"2024 EACTS\/EACTAIC\/EBCP Guidelines on cardiopulmonary bypass in adult cardiac surgery","volume":"40","author":"Wahba","year":"2025","journal-title":"Interdiscip. Cardiovasc. Thorac. Surg."},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"2215","DOI":"10.1053\/j.jvca.2023.07.011","article-title":"Appraisal of Postoperative Outcomes of Volatile and Intravenous Anesthetics: A Network Meta-Analysis of Patients Undergoing Cardiac Surgery","volume":"37","author":"Heybati","year":"2023","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"2399","DOI":"10.1053\/j.jvca.2023.07.030","article-title":"The Multimodal Cardioprotective Strategy in a Cardiac Surgery Trial: Predictable Neutral Results From a Questionable Design","volume":"37","author":"Pagel","year":"2023","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_114","doi-asserted-by":"crossref","unstructured":"Sun, Y., Sun, X., Wu, H., Xiao, Z., and Luo, W. (2025). A review of recent advances in anesthetic drugs for patients undergoing cardiac surgery. Front. Pharmacol., 16.","DOI":"10.3389\/fphar.2025.1533162"}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/16\/3\/138\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T09:10:21Z","timestamp":1772442621000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/16\/3\/138"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,1]]},"references-count":114,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["jpm16030138"],"URL":"https:\/\/doi.org\/10.3390\/jpm16030138","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,1]]}}}