Table 1.

Clinical studies of the protective effects of VAs

	Surgery	Patients and number (n)	Volatile anesthetics and dose	Outcome	Refs.
Cardioprotection	Cardiopulmonary bypass	n = 200	Sevoflurane 0.5–2%	Increase of troponin I ↓ Cardiac output ↑ Inotropic support ↓ Duration of stay in the ICU and hospital ↓	De Hert et al. [79]
	Cardiopulmonary bypass	Elderly high-riska patients, n = 45	Sevoflurane 0.5–2% Desflurane 1–4%	Decrease in cardiac index (CI) post-CPB ↓ Inotropic support ↓	De Hert et al. [80]
	Off-pump coronary artery bypass grafting	n = 48	Sevoflurane 1.0 MAC and 1.5 MAC	Post-surgical cardiac Troponin I ↓	Wang et al. [81]
	Off-pump coronary artery bypass	n = 45	Isoflurane 1.0–2.5%	Post-surgical cardiac index ↑ Increase of troponin T ↓	Tempe et al. [83]
	Off-pump coronary artery bypass	n = 60	Sevoflurane 0.7 and 1 MAC	Increase of troponin I ↓ Postoperative NT-proBNPb ↓ Inotropic support ↓	Guerrero Orriach et al. [84]
	On-pump coronary artery bypass	n = 45	Isoflurane 2.5% 10 minc	Hemodynamic recovery ↑ Cardiac troponin T ↓ CK-MB release ↓ Inotropic support ↓	Amr et al. [85]
Cerebral protection	Cardiopulmonary bypass	n = 128	Sevoflurane 0.6–1 MAC	Cognitive function ↑	Schoen et al. [91]
	Cardiopulmonary bypass	n = 92	Sevoflurane 0.5 MAC Isoflurane 0.5 MAC	Postoperative Mg disorders ↓ Increase in plasma MMP-9 and GFAPd concentration ↓	Dabrowski et al. [92]

CPB cardiopulmonary bypass, MAC minimal alveolar concentration

^aElderly high-risk: older than 70 years with three-vessel disease and an ejection fraction less than 50% with impaired length-dependent regulation of myocardial function

^bN-terminal pro-brain natriuretic peptide

^cPreconditioning with a 10-min exposure to isoflurane 2.5% followed by 5-min washout

^dSensitive marker of brain injury: matrix metalloproteinase-9 (MMP-9), glial fibrillary acidic protein (GFAP)