• Benu Makkad, Timothy Lee Heinke, and Miklos D Kertai.
• Department of Anesthesiology, University of Cincinnati Medical Center, Cincinnati, Ohio.
• Curr Opin Anaesthesiol. 2022 Feb 1; 35 (1): 183518-35.

Purpose Of ReviewPerioperative myocardial injury related to cardiac surgery is associated with organ dysfunction and increased mortality. Volatile anesthetics (VA) have been used during cardiac surgery for decades because of their direct and indirect preconditioning and protection against ischemia-reperfusion injury. The current review provides a summary of the latest literature comparing pharmacological preconditioning and the potential benefits of using VA versus total intravenous anesthesia (TIVA) for general anesthesia to improve outcomes after cardiac surgery.Recent FindingsRecent literature reports lower mortality and better outcomes when VA is used alone or in combination with remote ischemic preconditioning compared with groups receiving TIVA. However, inconsistent research findings over the years have led to continued debate regarding the anesthetic technique considered more favorable for cardiac surgery.SummaryResearch findings regarding the use of volatile anesthetic versus TIVA for better outcomes after cardiac surgery are inconsistent. Variability in timing, duration, dosing, and type of VA as well as surgical and patient-related factors may have influenced these results. Therefore, either technique can reasonably be adopted depending on provider and institutional preference and used safely in patients undergoing cardiac surgery.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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