Figure 2

(Hypothetical) Glucose and fatty acid metabolism under different conditions. Glucose and fatty acid metabolism in the healthy heart (A), during volatile anaesthesia (B), in the metabolic altered heart (C), in the ischaemic heart (D), during volatile anaesthesia in the ischemic heart (E) and during volatile anaesthesia in the ischemic metabolic altered heart (F). The healthy heart utilises 70% of fatty acids and 30% of glucose for ATP generation (A). We hypothesise that one of the mechanisms of volatile anaesthesia is the effect on increased glucose metabolism (B). In the metabolic altered heart it is suggested that myocardial substrate metabolism is shifted to increased fatty acid metabolism (C), whereas it is suggested that the ischaemic heart is shifted to increased glucose metabolism, however, also contrasting results exist (D). We hypothesise that exposure of volatile anaesthetics in the ischaemic heart might increase myocardial glucose metabolism even more (E), which is disturbed in the ischaemic and metabolic altered heart (F).