Introduction
Myocardial substrate metabolism
Type 2 diabetes mellitus
Ischaemia
The combination of type 2 diabetes mellitus and ischaemia
Effects of volatile anaesthetics in animals
Cardioprotective effects during ischaemia
Myocardial substrate metabolism during volatile anaesthesia
Alterations in cardioprotective mechanisms in the metabolic altered heart
Obesity and insulin resistance
Hyperlipidaemia
Acute hyperglycaemia
Type 2 diabetes mellitus
Experimental options to improve perioperative myocardial metabolism
Pharmacological interventions
Drug | Applicability | Advantages | Side-effects |
---|---|---|---|
Fatty acid metabolism inhibitors
| |||
Etomoxir | Stimulation glucose oxidation [99] | - | |
Perhexiline | T2DM, infarction [92] | Stimulation glucose oxidation | - |
Oxfenicine | Stimulation glucose oxidation | - | |
Trimetazidine | Stimulation glucose oxidation | - | |
Ranolazine | Stimulation glucose oxidation [96] | - | |
Dichloroacetate | T2DM, infarction [98] | Stimulation glucose oxidation [98] | - |
Insulin
| |||
Glucose-insulin-potassium | Infarction [103] | Stimulation glucose oxidation | Hypoglycaemia |
Insulin | T2DM | Reduction glucose levels | Hypoglycaemia |
Stimulation glucose oxidation | Hypoglycaemia | ||
PPAR agonists
| |||
Fibrates (PPARα) | T2DM [47] | Reduction lipids | Myopathy |
Reduction lipids | Myopathy | ||
Thiozolidinediones (PPARγ) | Insulin sensitizer | Increased risk heart attacks | |
Insulin sensitizer | Increased risk heart attacks | ||
Biguanide
| |||
Metformin | Stimulation glucose oxidation | Lactic acidosis | |
GLP1
| |||
GLP1 | T2DM, infarction [130] | Reduction glucose | Short half-life |
Exendin-4 | T2DM, infarction [131] | Reduction glucose | Hypoglycaemia |
Exenatide | T2DM, infarction [132] | Reduction glucose | Hypoglycaemia |
Liraglutide
| Reduction glucose | Hypoglycaemia |